Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-0060, Japan.
Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-0060, Japan.
Int J Cardiol. 2018 Apr 15;257:97-101. doi: 10.1016/j.ijcard.2017.12.089.
Association between the presence of left atrial low-voltage areas and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been shown mainly in persistent AF patients. We sought to compare the AF recurrence rate in paroxysmal AF patients with and without left atrial low-voltage areas.
This prospective observational study included 147 consecutive patients undergoing initial ablation for paroxysmal AF. Voltage mapping was performed after PVI during sinus rhythm, and low-voltage areas were defined as regions where bipolar peak-to-peak voltage was <0.50mV.
Left atrial low-voltage areas after PVI were observed in 22 (15%) patients. Patients with low-voltage areas were significantly older (72±6 vs. 66±10, p<0.0001), more likely to be female (68% vs. 32%, p=0.002), and had higher CHADS-VASc score (2.5±1.5 vs. 1.8±1.3, p=0.028). During a mean follow-up of 22 (18, 26) months, AF recurrence was observed in 24 (16%) and 16 (11%) patients after the single and multiple ablation procedures, respectively. AF recurrence rate after multiple ablations was higher in patients with low-voltage areas than without (36% vs. 6%, p<0.001). Low-voltage areas were independently associated with AF recurrence even after adjustment for the other related factors (Hazard ratio, 5.89; 95% confidence interval, 2.16 to 16.0, p=0.001).
The presence of left atrial low-voltage areas after PVI predicts AF recurrence in patients with paroxysmal AF as well as in patients with persistent AF.
左心房低电压区与肺静脉隔离（PVI）后心房颤动（AF）复发之间的关联主要在持续性 AF 患者中得到证实。我们旨在比较阵发性 AF 患者中存在和不存在左心房低电压区的 AF 复发率。
这项前瞻性观察性研究纳入了 147 例因阵发性 AF 初次消融的连续患者。窦性心律时在 PVI 后进行电压测绘，将双极峰峰值电压<0.50mV 的区域定义为低电压区。
PVI 后观察到 22 例（15%）患者存在左心房低电压区。低电压区患者明显更年长（72±6 岁 vs. 66±10 岁，p<0.0001）、更可能为女性（68% vs. 32%，p=0.002），且 CHADS-VASc 评分更高（2.5±1.5 分 vs. 1.8±1.3 分，p=0.028）。在平均 22（18，26）个月的随访期间，单次和多次消融后分别有 24（16%）和 16（11%）例患者发生 AF 复发。低电压区患者的多次消融后 AF 复发率高于无低电压区患者（36% vs. 6%，p<0.001）。即使在调整其他相关因素后，低电压区仍与 AF 复发独立相关（风险比，5.89；95%置信区间，2.16 至 16.0，p=0.001）。
PVI 后左心房低电压区的存在可预测阵发性 AF 患者以及持续性 AF 患者的 AF 复发。
