Atrial fibrillatory wave amplitude revisited: A predictor of recurrence after catheter ablation independent of the degree of left atrial structural remodeling

Figures

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  Figure 1. Lack of a correlation between the atrial fibrillatory wave amplitude (FWA) and low-voltage area (LVA) in paroxysmal atrial fibrillation (AF) patients. A low FWA would be expected to have a larger LVA. Examples of QRST-subtracted atrial electrocardiograms and electroanatomical voltage maps, which did not follow that expectation are shown. The high FWA patient (A) had a larger LVA than the low FWA patient (B). The low FWA patient had an AF/atrial tachyarrhythmia (AT) recurrence during the follow-up but the high FWA patient did not.

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  Figure 2. Lack of a correlation between the fibrillatory wave amplitude (FWA) and low-voltage area (LVA) in non-paroxysmal atrial fibrillation (AF) patients. In these examples, the high FWA patient (A) had a larger LVA than the low FWA patient (B), similarly to paroxysmal AF patients as shown in Figure 1. The low FWA patient had recurrence, but the high FWA patient did not.

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  Figure 3. Relationship between the fibrillatory wave amplitude (FWA) and low-voltage area (LVA) in the subdivided left atrial (LA) regions (A. Anterior; B. Posterior; C. Inferior; D. Septal; E. Roof) and whole LA (F). No significant correlation between the FWA and LVA was noted in the whole LA or any subdivided LA region.

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  Figure 4. Total left atrial (LA) activation time and local LA conduction velocity (CV). A. The local LA CV was calculated by dividing the distance from the inferior ostium of the left inferior pulmonary vein (PV) to the superior ostium of the right superior PV (arrow) by the conduction time between these two sites. The total LA activation time (B) and local LA CV (C) did not differ between the high and low FWA groups; PA — postero-anterior view; LAT — local activation time.

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  Figure 5. Kaplan-Meier survival curves showing the freedom from atrial tachyarrhythmias after a single ablation procedure stratified by the fibrillatory wave amplitude (FWA) (A) and combination of the FWA and left atrial size (B); LAVI — left atrial volume index.

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  Figure 6. Relationship between the fibrillatory wave amplitude and left atrial volume index (LAVI) in paroxysmal atrial fibrillation (AF) (A) and non-paroxysmal AF (B) patients. The closed black dots represent patients with recurrent atrial tachyarrhythmias after catheter ablation; FWA — fibrillatory wave amplitude.