Key result
Higher low voltage zone area significantly predicted late recurrence of atrial fibrillation (HR 1.352) and demonstrated superior predictive value (AUC 0.676) compared to left atrial diameter (AUC 0.592).
Why the study?
LA diameter reflects structural rather than electrical remodeling, prompting evaluation of the predictive value of electrical remodeling represented by low voltage zone amount.
Does electrical remodeling (low voltage zone) predict late recurrence better than structural remodeling (left atrial diameter) in atrial fibrillation patients undergoing radiofrequency catheter ablation?
Cohort (n=537)
No
Does electrical remodeling (low voltage zone) predict late recurrence better than structural remodeling (left atrial diameter) in atrial fibrillation patients undergoing radiofrequency catheter ablation?
Hazard Ratio: 1.352 (95% CI 1.102–1.658)
p-value: p=0.004
Electrical remodeling (low voltage zone) is a superior predictor of atrial fibrillation recurrence after radiofrequency catheter ablation compared to traditional structural remodeling markers like left atrial diameter.
May support voltage mapping for post-ablation recurrence risk stratification; leaves open whether it improves outcomes over diameter alone in prospective trials.
BACKGROUND AND OBJECTIVES: Recurrence rates after radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients are not low especially in non-paroxysmal AF. The diameter of left atrium (LA) has been widely used to predict the recurrence after RFCA for decades. However, LA diameter represents structural remodeling of LA and does not reflect electrical remodeling. We aimed to determine the predictive value of electrical remodeling of LA which is represented by the amount of low voltage zone (LVZ). METHODS: We performed a retrospective cohort analysis of AF patients who underwent de novo RFCA in a single-center. RESULTS: A total of 3,120 AF patients with de novo RFCA were analyzed. Among these patients, 537 patients underwent an electroanatomic mapping with bipolar voltage measurement of LA. The diameter of LA and flow velocity of LA appendage (LAA) differed significantly according to quartile group of LVZ area and percentage: patients with high LVZ had large LA diameter and low LAA flow velocity (p<0.001). Freedom from late recurrence (LR) was significantly lower in patients with high LVZ area and percentage (p<0.001). The diameter and surface area of LA had area under curve (AUC) of 0.592 and 0.593, respectively (p=0.002 for both). The predictive value of LVZ area (AUC, 0.676) and percentage (AUC, 0.671) were both superior compared with LA diameter (p=0.011 and 0.027 for each comparison). CONCLUSIONS: In conclusion, LVZ can predict freedom from LR after RFCA in AF patients. Predictive value was higher in parameters reflecting electrical rather than structural remodeling of LA.
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Kim et al. (2022) conducted a cohort in Atrial Fibrillation (n=537). Low voltage zone (LVZ) area vs. Lower LVZ area / Left atrial diameter was evaluated on Late recurrence of atrial tachyarrhythmia (HR 1.352, 95% CI 1.102-1.658, p=0.004). Higher low voltage zone area significantly predicted late recurrence of atrial fibrillation (HR 1.352) and demonstrated superior predictive value (AUC 0.676) compared to left atrial diameter (AUC 0.592).
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