Classification of Left Atrial Diseased Tissue Burden Determined by Automated Voltage Analysis Predicts Outcomes After Ablation for Atrial Fibrillation

Overview

Journal Dis Markers

Publisher Wiley

Specialty Biochemistry

Date 2021 Jul 14

PMID 34257744

Citations 1

Authors

Szilvia Herczeg

John J Keaney

Edward Keelan

Claire Howard

Katie Walsh

Laszlo Geller

Gabor Szeplaki

Joseph Galvin

Affiliations

Soon will be listed here.

Abstract

Background: The burden and persistence of atrial fibrillation (AF) have been associated with the presence and extent of left atrial (LA) fibrosis. Recent reports have implicated an association between the extent of LA fibrosis and the outcome of pulmonary vein isolation (PVI). We aimed to analyse the value of an automated scar quantification method in the prediction of success following PVI.

Methods: One hundred and nine consecutive patients undergoing PVI for paroxysmal or persistent AF were included in our observational study with a 2-year follow-up. Prior to PVI, patients underwent high-definition LA electroanatomical mapping, and scar burden was quantified by automated software (Voltage Histogram Analysis, CARTO 3, Biosense Webster), then classified into 4 subgroups (Dublin Classes I-IV). Recurrence rates were analysed on and off antiarrhythmic drug therapy (AAD), respectively.

Results: The overall success rate was 74% and 67% off AAD at 1- and 2-year follow-up, respectively. Patients with Dublin Class IV had significantly lower success rates ( = 0.008, off AAD). Dublin Class IV (OR = 2.27, = 0.022, off AAD) and the presence of arrhythmia in the blanking period (OR = 3.28, = 0.001, off AAD) were the only significant predictors of recurrence. The use of AAD did not affect these results.

Conclusions: We propose a classification of low voltage areas based on automated quantification by software during 3D mapping prior to PVI. Patients with high burden of low voltage areas (>31% of <0.5 mV, Dublin Class IV) have a higher risk of recurrence following PVI. Information gathered during electroanatomical mapping may have important prognostic value.

Citing Articles

Long-term results of ablation index guided atrial fibrillation ablation: insights after 5+ years of follow-up from the MPH AF Ablation Registry.

Fitzpatrick N, Herczeg S, Hong K, Seaver F, Rosalejos L, Boles U Front Cardiovasc Med. 2024; 10:1332868.

PMID: 38292455 PMC: 10825003. DOI: 10.3389/fcvm.2023.1332868.

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