Extensive Left Atrial Low-Voltage Area During Initial Ablation is Associated with A Poor Clinical Outcome Even Following Multiple Procedures

Overview

Journal J Atr Fibrillation

Date 2021 Dec 24

PMID 34950372

Authors

Takashi Kanda

Masaharu Masuda

Mitsutoshi Asai

Osamu Iida

Shin Okamoto

Takayuki Ishihara

Kiyonori Nanto

Takuya Tsujimura

Yasuhiro Matsuda

Yosuke Hata

Hiroyuki Uematsu

Toshiaki Mano

Affiliations

Soon will be listed here.

Abstract

Background: Some patients fail to respond to persistent atrial fibrillation (PeAF) catheter ablation in spite of multiple procedures and ablation strategies, including low voltage area (LVA)-guided, linear, and complex fractionated atrial electrogram (CFAE)-guided ablation procedures. We hypothesized that LVA extent could predict non-responseto Pe AF catheter ablation in spite of multiple procedures.

Methods: This study included 510 patients undergoing initial ablation procedures for PeAF. LVAs were defined as regions with bipolar peak-to-peak voltages of <0.50 mV after PVI during sinus rhythm. Patients were categorized by LVA size into groups A(0-5 cm), B (5-20 cm), and C (over 20 cm). The primary endpoint was AF-free survival after the last procedure.

Results: During a median follow-up of 25 (17, 36) months, AF recurrence was observed in 101 (20%) patients after 1.4±0.6 ablation procedures (maximum 4). Comparison of clinical outcomes after multiple procedures in the three groups showed that the results depended on the extent of LVA. Multivariate analysis of AF-free survival after the last procedure showed that LVAs > 20 cm2 was an independent factor associated with AF recurrence after the final procedure(Hazard ratio, 7.94; 95% confidence interval, 2.91 to 21.67, P <0.001).

Conclusions: Extensive LVA after initial PVI was associated with poor clinical benefit despite multiple catheter based ablations.

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