Teumer Yannick, Gold Luca, Katov Lyuboslav, Bothner Carlo, Rottbauer Wolfgang, Weinmann-Emhardt Karolina
Internal Medicine II, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
J Cardiovasc Dev Dis. 2024 Oct 21;11(10):334. doi: 10.3390/jcdd11100334.
The incidence of left atrial (LA) supraventricular arrhythmias is increasing. Even after LA ablation, recurrence of these tachycardias is common. MRI studies show that LA cardiomyopathy is a significant risk factor for recurrence and correlates with low voltage areas detected via 3D electroanatomic mapping (EAM). There are limited data on the impact of low voltage extent detected by EAM on recurrence-free survival. Voltage thresholds defining low voltage vary across different studies. This study aims to investigate the impact of the extent of low voltage areas in the LA on recurrence-free survival and to assess whether defining low voltage areas using thresholds of 0.5, 0.4, or 0.3 mV offers better predictive performance. Patients with atrial arrhythmia who underwent LA EAM at Ulm University Heart Center between September 2018 and September 2022 were included from the ATRIUM registry. ROC analysis determined the voltage threshold for predicting recurrence-free survival. Kaplan-Meier and logistic regression models adjusted for patient variables were used to analyze recurrence-free survival. Of 1089 screened patients, 108 met the inclusion criteria. ROC analysis indicated that a 0.4 mV threshold for low voltage provided the best predictive performance. Logistic regression showed a 1.039-fold increase in recurrence risk per percent increase in LA low voltage area (odds ratio = 1.039, 95% CI 1.014-1.064). Low voltage extent in EAM correlates with 1-year recurrence rate after ablation of left atrial supraventricular arrhythmias. The threshold of 0.4 mV is the most suitable for predicting recurrences of those examined.
左心房（LA）室上性心律失常的发生率正在上升。即使在LA消融术后，这些心动过速的复发也很常见。MRI研究表明，LA心肌病是复发的一个重要危险因素，并且与通过三维电解剖标测（EAM）检测到的低电压区域相关。关于EAM检测到的低电压范围对无复发生存的影响的数据有限。不同研究中定义低电压的电压阈值各不相同。本研究旨在探讨LA中低电压区域的范围对无复发生存的影响，并评估使用0.5、0.4或0.3 mV阈值定义低电压区域是否具有更好的预测性能。从ATRIUM注册研究中纳入了2018年9月至2022年9月在乌尔姆大学心脏中心接受LA EAM的房性心律失常患者。ROC分析确定了预测无复发生存的电压阈值。使用针对患者变量进行调整的Kaplan-Meier和逻辑回归模型来分析无复发生存情况。在1089名筛查患者中，108名符合纳入标准。ROC分析表明，低电压的0.4 mV阈值具有最佳预测性能。逻辑回归显示，LA低电压区域每增加1%，复发风险增加1.039倍（比值比 = 1.039，95% CI 1.014 - 1.064）。EAM中的低电压范围与左房室上性心律失常消融术后的1年复发率相关。0.4 mV的阈值最适合预测所检查患者的复发情况。
