The relationship between the 3D electroanatomical mapping parameters of the left atrial posterior wall and the recurrence of paroxysmal atrial fibrillation.

BACKGROUND

Pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation in paroxysmal atrial fibrillation (PAF). However, the recurrence of AF after PVI needs further investigation. The left atrial posterior wall (LAPW) is embryologically related to the pulmonary vein and plays an important role in the initiation and maintenance of AF. This study aims to explore the relationship between the 3D electroanatomical mapping parameters of the LAPW and recurrence in patients with PAF.

METHODS

A retrospective analysis was conducted on patients with PAF who underwent PVI. Both clinical and procedural characteristics from the enrolled subjects were collected before PVI. 3D electroanatomical mapping anatomical and electrical parameters were measured and calculated in the CARTO system. Intergroup comparisons and multivariate logistic regression analysis were performed to demonstrate the relationship between the parameters of LAPW and AF recurrence. A combined prediction model for AF recurrence was constructed in this study.

RESULTS

A total of 120 patients were included in the final analysis. Among procedural characteristics, compared with Group 1 (no recurrence), there was a significantly larger posterior wall surface area (PWSA) ( = 0.013) and a percentage of very low-voltage area (PVLVA) ( < 0.001) in Group 2 (recurrence). Further analysis revealed that there was a significant difference between the two groups in terms of the distribution of VLVA ( = 0.026). Subsequently, in a multivariate logistic regression analysis, both PWSA and PVLVA were found to be independent risk factors for AF recurrence [odds ratio (OR): 1.457, 95% confidence interval (CI): 1.037-2.049,  = 0.030; OR: 1.059, 95% CI: 1.013-1.107,  = 0.012, respectively]. Finally, a prediction model that combined the PWSA with the PVLVA for AF recurrence was constructed to draw the receiver operating characteristic curve. The area under the curve of this model was 0.900 (0.827-0.973) ( < 0.001). The result, evaluated by using the Hosmer-Lemeshow goodness-of-fit test, showed that χ = 4.643 ( = 0.796).

CONCLUSIONS

This study demonstrates that both PWSA and PVLVA were independent risk factors for AF recurrence. Moreover, we proposed a model that combined the PWSA with the PVLVA to predict the recurrence of AF, which may provide an approach for screening patients with PAF who may require attention for the LAPW.