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Prediction of low-voltage areas using modified APPLE score
Timm Seewöster1, Falco Kosich1, Philipp Sommer2
1Department of Electrophysiology, Heart Center at Leipzig University, Leipzig, Germany.
A modified APPLE score using left atrial volume and emptying fraction shows good prognostic value for predicting low-voltage areas in atrial fibrillation patients. This score is comparable to the standard APPLE score for guiding individualized AF management.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Low-voltage areas (LVAs) in atrial fibrillation (AF) indicate left atrial (LA) substrate crucial for treatment.
- Previous prediction scores for LVAs used less accurate LA diameter and did not directly link impaired left ventricular ejection fraction (LV-EF) to atrial myopathy.
Purpose of the Study:
- To compare a modified APPLE (mAPPLE) score, incorporating LA volume (LAV) and LA emptying fraction (LA-EF), with the standard APPLE score for predicting LVAs.
- To assess the accuracy of LAV and LA-EF in reflecting the atrial substrate compared to traditional echocardiographic measures.
Main Methods:
- A cohort of 219 patients undergoing first AF catheter ablation were analyzed.
- LVAs were identified using high-density mapping during ablation.
- Cardiovascular magnetic resonance imaging was performed pre-interventionally. The APPLE and mAPPLE scores were calculated using baseline data.
Main Results:
- Both APPLE and mAPPLE scores were significantly associated with the presence of LVAs.
- The mAPPLE score demonstrated a higher area under the curve (0.779) compared to the APPLE score (0.704) in predicting LVAs, though not statistically significant (P=0.233).
- The study included 219 patients with a median age of 65 years, 41% females, 59% with persistent AF, and 25% having LVAs.
Conclusions:
- The modified APPLE score offers good prognostic value for predicting LVAs in AF patients.
- The mAPPLE score is a valuable tool for assessing the atrial substrate and is comparable to the standard APPLE score.
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