Left atrial fibrosis quantified by low-voltage areas on bipolar voltage maps strongly predicted atrial fibrillation recurrence after radiofrequency ablation (AUC 0.834 and 0.832, p < 0.001).
Cohort (n=106)
Does the degree of left atrial fibrosis quantified by low-voltage areas predict atrial fibrillation recurrence after radiofrequency catheter ablation?
Left atrial fibrosis measured by bipolar voltage mapping is a strong, independent predictor of atrial fibrillation recurrence following radiofrequency catheter ablation.
Effect estimate: AUC 0.834 and 0.832
p-value: p=< 0.001
Atrial fibrillation (AF), the most frequently encountered arrhythmia worldwide, is associated with increased cardiovascular morbidity and mortality. Left atrial (LA) and antral region of the pulmonary veins (PVs) remodeling are risk factors for AF perpetuation. Among the methods of LA fibrosis quantification, bipolar voltage mapping during three-dimensional electro-anatomical mapping is less studied. The main aim of this study was to analyze the relationship between the degree of LA fibrosis quantified in low-voltage areas and the efficacy of AF radiofrequency catheter ablation. All consecutive patients with AF ablation were included, and the degree of LA fibrosis was measured based on the low-voltage areas in the LA and the antral region of PVs (<0.5 mV for patients in sinus rhythm and <0.25 mV for patients in AF at the time of the ablation procedure). The efficacy of AF ablation was determined by the rate of recurrence after a blanking period of three months. A total of 106 patients were included; from these, 38 (35.8%) had AF recurrence after RF ablation, while 68 (64.2%) were free of events. The area and percentage of LA fibrosis were significantly higher in the patients with AF recurrence (p = 0.018 and p = 0.019, respectively). However, no significant differences were found between the patients with and without AF recurrence in terms of the area and percentage of PVs fibrosis (p = 0.896 and p = 0.888, respectively). Moreover, LA fibrosis parameters proved to be excellent predictors for AF recurrence (areas under the curve of 0.834 and 0.832, respectively, p < 0.001) even after adjustment for LA indexed volume and CHA2DS2-VASc score. In conclusion, LA fibrosis measured on bipolar voltage maps increases the risk of AF recurrence after the RF catheter ablation procedure.
Mitran et al. (Sat,) conducted a cohort in Atrial fibrillation (n=106). Left atrial fibrosis quantification via bipolar voltage mapping was evaluated on Atrial fibrillation recurrence after a blanking period of three months (AUC 0.834 and 0.832, p=< 0.001). Left atrial fibrosis quantified by low-voltage areas on bipolar voltage maps strongly predicted atrial fibrillation recurrence after radiofrequency ablation (AUC 0.834 and 0.832, p < 0.001).