Department of Cardiology, Brandenburg Medical School (MHB) Theodor Fontane, University Hospital Heart Center Brandenburg, Neuruppin, Germany.
Faculty of Health Sciences Brandenburg, Neuruppin, Germany.
J Cardiovasc Electrophysiol. 2024 Jun;35(6):1156-1164. doi: 10.1111/jce.16266. Epub 2024 Apr 3.
Left atrial (LA) low voltage areas (LVA) are a controversial target in atrial fibrillation ablation procedures. However, LVA and LA volume are good predictors of arrhythmia recurrence in ablation-naïve patients. Their predictive value in progressively diseased pre-ablated atria is uncertain.
Consecutive patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT), who were scheduled for repeat LA ablation, were enrolled in the prospective Bernau ablation registry between 2016 and 2020. All patients received a complete LA ultrahigh-density map before ablation. Maps were analyzed for LA size, LVA percentage and distribution. The predictive value of demographic, anatomic, and mapping variables on AF recurrence was analyzed.
160 patients (50.6% male, 1.3 pre-ablations, 60% persistent AF) with complete LA voltage maps were included. Mean follow-up time was 16 ± 11 months. Mean recorded electrograms (EGMs) per map were 9754 ± 5808, mean LA volume was 176.1 ± 35.9 ml and mean rate of LVAs <0.5 mV was 30.6% ± 23.1%. During follow-up recurrence rate of AF or AT >30 s was 55.6%. Patients with recurrence had a significant higher percentage of LVAs (40.0% vs. 18.8%, p < .001) but no relevant difference in LA volume (172 vs. 178 mL, p = .299). ROC curves revealed LVA as a good predictor for recurrence (AUC = 0.79, p < .001) and a cut-off of 22% LVAs with highest sensitivity (73.0%) and specificity (71.8%). Based on this cut off, event free survival was significantly higher in the Low LVA group (p < .01).
Total LVA percentage has a good predictive power on arrhythmia recurrence in a cohort of advanced scarred left atria in repeat procedures independent of the applied ablation strategy. Left atrial volume seems to have minor impact on the rhythm outcome in our study cohort.
左心房（LA）低电压区域（LVA）是房颤消融术中有争议的靶点。然而，LVA 和 LA 容积是消融初治患者心律失常复发的良好预测指标。它们在逐渐病变的消融前左心房中的预测价值尚不确定。
连续入选 2016 年至 2020 年期间因复发性房颤（AF）或房性心动过速（AT）而接受再次 LA 消融的患者，纳入前瞻性 Bernau 消融登记研究。所有患者在消融前均接受完整的 LA 超高密度图。分析地图的 LA 大小、LVA 百分比和分布。分析人口统计学、解剖学和映射变量对 AF 复发的预测价值。
共纳入 160 例（50.6%男性，1.3 次消融，60%持续性 AF）患者，均有完整的 LA 电压图。平均随访时间为 16±11 个月。平均每个图记录的电活动（EGM）为 9754±5808，平均 LA 容积为 176.1±35.9ml，平均 LVA<0.5mV 率为 30.6%±23.1%。随访期间，AF 或 AT>30s 的复发率为 55.6%。复发患者的 LVA 百分比明显更高（40.0%比 18.8%，p<0.001），但 LA 容积无明显差异（172 比 178ml，p=0.299）。ROC 曲线显示 LVA 是复发的良好预测指标（AUC=0.79，p<0.001），LVA 百分比为 22%时具有最高的灵敏度（73.0%）和特异性（71.8%）。基于此切点，低 LVA 组的无事件生存率明显更高（p<0.01）。
在重复消融的晚期瘢痕累累的左心房队列中，总 LVA 百分比是心律失常复发的良好预测指标，与所应用的消融策略无关。LA 容积在本研究队列的节律结果中似乎影响较小。
