What does this research mean for the field?

The SPEED score, which incorporates female sex, persistent atrial fibrillation, age ≥ 70 years, elevated natriuretic peptides, and diabetes mellitus, accurately predicts the prevalence of left atrial low-voltage areas in patients undergoing atrial fibrillation ablation. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 23, 2020

A new clinical risk score for predicting the prevalence of low‐voltage areas in patients undergoing atrial fibrillation ablation

Structured PICO

Does the SPEED score predict the prevalence of left atrial low-voltage areas in patients undergoing initial ablation for atrial fibrillation?

Population

1004 consecutive patients undergoing initial ablation for atrial fibrillation, mean age 68 ± 10 years, 34% female, 51% with persistent AF.

Intervention

SPEED score assessment (female sex, persistent AF, age ≥ 70 years, elevated BNP ≥100 pg/ml or NT-proBNP ≥400 pg/ml, and diabetes mellitus)

Outcome

Presence of left atrial low-voltage areas (LVAs) defined as peak-to-peak bipolar voltage of <0.5 mV covering ≥5 cm2 of the left atrium after pulmonary vein isolationsurrogate

The SPEED score is a simple clinical tool that can accurately predict the presence of left atrial low-voltage areas prior to AF ablation, potentially guiding ablation strategy.

Abstract

Abstract Introduction Although the presence of left atrial low‐voltage areas (LVAs) is strongly associated with the recurrence of atrial fibrillation (AF) after ablation, few methods are available to classify the prevalence of LVAs. The purpose of this study was to establish a risk score for predicting the prevalence of LVAs in patients undergoing ablation for AF. Methods We enrolled 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; female, 346 (34%) ; persistent AF, 513 (51%) ). LVAs were deemed present when the voltage map after pulmonary vein isolation demonstrated low‐voltage areas with a peak‐to‐peak bipolar voltage of <0. 5 mV covering ≥5 cm 2 of the left atrium. Results LVAs were present in 206 (21%) patients. The SPEED score was obtained as the total number of independent predictors as identified on multivariate analysis, namely female sex (odds ratio OR, 3. 4 95% confidence interval CI 2. 2–5. 2, p <. 01), persistent AF (OR, 1. 8 95% CI, 1. 1–3. 0, p =. 02), age ≥ 70 years (OR, 2. 3 95% CI, 1. 5–3. 4, p <. 01), elevated brain natriuretic peptide ≥100 pg/ml or N‐terminal probrain natriuretic peptide ≥400 pg/ml (OR, 1. 7 95% CI, 1. 02–2. 8, p =. 04), and diabetes mellitus (OR, 1. 8 95% CI, 1. 1–2. 8, p =. 02). LVAs were more frequent in patients with a higher SPEED score, and prevalence increased with each additional SPEED score point (OR, 2. 4 95% CI, 2. 0–2. 8, p <. 01). Conclusion The SPEED score accurately predicts the prevalence of LVAs in patients undergoing ablation for AF.

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