TY - JOUR
T1 - The Extent of Left Atrial Low-Voltage Areas Included in Pulmonary Vein Isolation Is Associated With Freedom from Recurrent Atrial Arrhythmia
AU - Huang, Dong
AU - Li, Jing bo
AU - Zghaib, Tarek
AU - Gucuk Ipek, Esra
AU - Balouch, Muhammad
AU - Spragg, David D.
AU - Ashikaga, Hiroshi
AU - Tandri, Harikrishna
AU - Sinha, Sunil K.
AU - Marine, Joseph E.
AU - Berger, Ronald D.
AU - Calkins, Hugh
AU - Nazarian, Saman
N1 - Funding Information:
S.N. is a consultant to Biosense Webster and CaarioSolv and has received research funding from Biosense Webster and the National Institutes of Health. The other authors have no conflicts of interest to disclose.
Funding Information:
This study was funded by a Biosense Webster grant and National Institutes of Health (NIH) Grant R01HL116280 to S.N., a grant from the Science and Technology Commission of Shanghai Municipality (No. 14ZR1432000) and the National Nature Science Foundation of China (NSFC, No. 81571363) to D.H., and the Dr Francis P. Chiaramonte Foundation, the Norbert and Louise Grunwald Cardiac Arrhythmia Fund, the Marv Weiner Cardiac Arrhythmia Fund, and the Marilyn and Christian Poindexter Research Fund. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the NSFC.
Publisher Copyright:
© 2017 Canadian Cardiovascular Society
PY - 2018/1
Y1 - 2018/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.cjca.2017.10.012
DO - 10.1016/j.cjca.2017.10.012
M3 - Article
C2 - 29275886
AN - SCOPUS:85039949504
SN - 0828-282X
VL - 34
SP - 73
EP - 79
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
IS - 1
ER -