Dong Huang1, Jing-Bo Li2, Tarek Zghaib3, Esra Gucuk Ipek3, Muhammad Balouch3, David D Spragg3, Hiroshi Ashikaga3, Harikrishna Tandri3, Sunil K Sinha3, Joseph E Marine3, Ronald D Berger3, Hugh Calkins3, Saman Nazarian4. 1. Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Section for Cardiac Electrophysiology, Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China. 3. Section for Cardiac Electrophysiology, Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 4. Section for Cardiac Electrophysiology, Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Section for Cardiac Electrophysiology, Department of Medicine/Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. Electronic address: saman.nazarian@uphs.upenn.edu.
Abstract
BACKGROUND: The extent of left atrial (LA) baseline low-voltage areas (LVA-B), which may be a surrogate for fibrosis, is associated with recurrent atrial fibrillation (AF) after ablation. This study aimed to assess the relationship between the extent of LVA-B isolated by ablation (LVA-I) and AF recurrence. METHODS: The study cohort included 159 consecutive patients with drug-refractory AF who underwent an initial AF ablation with LA voltage mapping during sinus rhythm. The extent of LVA-B was quantified while excluding the pulmonary veins, LA appendage, and mitral valve area. LVA-I was quantified as the percentage of LVA-B encircled by pulmonary vein isolation. Surveillance and symptom-prompted electrocardiograms, Holter monitors, and event monitors were used to document atrial arrhythmia recurrence for a median follow-up of 712 days (1.95 years). RESULTS: Of 159 patients, 72% were men and 27% had persistent AF. The mean number of sampled bipolar voltage points was 119 ± 56. The mean LA surface area was 102.3 ± 37.3 cm2, and the mean LVA-B was 1.9 ± 3.8 cm2. The mean LVA-I was 51.05% ± 36.8% of LVA-B. In the multivariable Cox proportional hazards model adjusted for LA volume, CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age [≥ 75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female] score), LVA-B, and AF type, LVA-I was inversely associated with recurrent atrial arrhythmia after the blanking period (hazard ratio, 0.42/percent LVA isolated; P = 0.037). CONCLUSIONS: The extent of LVA-I is independently associated with freedom from atrial arrhythmias after AF ablation, supporting ongoing efforts to target low LA voltage areas and other fibrosis indicators to improve ablation outcomes.
BACKGROUND: The extent of left atrial (LA) baseline low-voltage areas (LVA-B), which may be a surrogate for fibrosis, is associated with recurrent atrial fibrillation (AF) after ablation. This study aimed to assess the relationship between the extent of LVA-B isolated by ablation (LVA-I) and AF recurrence. METHODS: The study cohort included 159 consecutive patients with drug-refractory AF who underwent an initial AF ablation with LA voltage mapping during sinus rhythm. The extent of LVA-B was quantified while excluding the pulmonary veins, LA appendage, and mitral valve area. LVA-I was quantified as the percentage of LVA-B encircled by pulmonary vein isolation. Surveillance and symptom-prompted electrocardiograms, Holter monitors, and event monitors were used to document atrial arrhythmia recurrence for a median follow-up of 712 days (1.95 years). RESULTS: Of 159 patients, 72% were men and 27% had persistent AF. The mean number of sampled bipolar voltage points was 119 ± 56. The mean LA surface area was 102.3 ± 37.3 cm2, and the mean LVA-B was 1.9 ± 3.8 cm2. The mean LVA-I was 51.05% ± 36.8% of LVA-B. In the multivariable Cox proportional hazards model adjusted for LA volume, CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age [≥ 75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female] score), LVA-B, and AF type, LVA-I was inversely associated with recurrent atrial arrhythmia after the blanking period (hazard ratio, 0.42/percent LVA isolated; P = 0.037). CONCLUSIONS: The extent of LVA-I is independently associated with freedom from atrial arrhythmias after AF ablation, supporting ongoing efforts to target low LA voltage areas and other fibrosis indicators to improve ablation outcomes.
Authors: Timm Seewöster; Petra Büttner; Sotirios Nedios; Philipp Sommer; Nikolaos Dagres; Katja Schumacher; Andreas Bollmann; Sebastian Hilbert; Cosima Jahnke; Ingo Paetsch; Gerhard Hindricks; Jelena Kornej Journal: J Am Heart Assoc Date: 2018-10-02 Impact factor: 5.501