Key result
Extensive left atrial low-voltage areas (>20 cm2) after initial pulmonary vein isolation were independently associated with a higher risk of atrial fibrillation recurrence (HR 7.94) despite multiple ablation procedures.
Why the study?
Some patients fail to respond to persistent atrial fibrillation catheter ablation despite multiple procedures, motivating the hypothesis that low-voltage area extent predicts non-response.
Does the extent of left atrial low-voltage area (LVA) predict atrial fibrillation recurrence in patients with persistent AF undergoing multiple catheter ablation procedures?
Cohort (n=510)
No
Does the extent of left atrial low-voltage area (LVA) predict atrial fibrillation recurrence in patients with persistent AF undergoing multiple catheter ablation procedures?
Extensive left atrial low-voltage areas (>20 cm2) identified during initial ablation for persistent atrial fibrillation strongly predict arrhythmia recurrence, even after multiple ablation procedures.
BACKGROUND: Some patients fail to respond to persistent atrial fibrillation (PeAF) catheter ablation in spite of multiple procedures and ablation strategies, including low voltage area (LVA)-guided, linear, and complex fractionated atrial electrogram (CFAE)-guided ablation procedures. We hypothesized that LVA extent could predict non-responseto Pe AF catheter ablation in spite of multiple procedures. METHODS: ). The primary endpoint was AF-free survival after the last procedure. RESULTS: During a median follow-up of 25 (17, 36) months, AF recurrence was observed in 101 (20%) patients after 1.4±0.6 ablation procedures (maximum 4). Comparison of clinical outcomes after multiple procedures in the three groups showed that the results depended on the extent of LVA. Multivariate analysis of AF-free survival after the last procedure showed that LVAs > 20 cm2 was an independent factor associated with AF recurrence after the final procedure(Hazard ratio, 7.94; 95% confidence interval, 2.91 to 21.67, P <0.001). CONCLUSIONS: Extensive LVA after initial PVI was associated with poor clinical benefit despite multiple catheter based ablations.
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A 2021 study conducted a cohort in Persistent Atrial Fibrillation (n=510). Extensive left atrial low-voltage areas (>20 cm2) vs. No or smaller left atrial low-voltage areas (≤20 cm2) was evaluated on AF-free survival after the last procedure (HR 7.94, 95% CI 2.91-21.67, p=<0.001). Extensive left atrial low-voltage areas (>20 cm2) after initial pulmonary vein isolation were independently associated with a higher risk of atrial fibrillation recurrence (HR 7.94) despite multiple ablation procedures.
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