Extensive Left Atrial Low-Voltage Area During Initial Ablation is Associated with A Poor Clinical Outcome Even...

Area of Science:

• Electrophysiology
• Cardiology
• Medical Devices

Background:

• Persistent atrial fibrillation (PeAF) catheter ablation success rates vary, with some patients unresponsive to multiple ablation strategies.
• Low voltage areas (LVAs) are potential targets, but their predictive value for ablation outcomes requires further investigation.

Purpose of the Study:

• To investigate whether the extent of low voltage areas (LVAs) after pulmonary vein isolation (PVI) can predict non-response to catheter ablation in patients with persistent atrial fibrillation (PeAF).

Main Methods:

• 510 patients undergoing initial PeAF ablation were analyzed.
• LVAs (<0.50 mV) were measured post-PVI in sinus rhythm and categorized by size (0-5 cm², 5-20 cm², >20 cm²).
• AF-free survival after the last procedure was the primary endpoint.

Main Results:

• AF recurrence occurred in 20% of patients after a median of 1.4 procedures.
• Outcomes varied significantly based on LVA size.
• LVAs > 20 cm² independently predicted AF recurrence (HR 7.94, P <0.001).

Conclusions:

• Extensive LVAs (>20 cm²) identified after initial PVI are associated with poor clinical outcomes.
• Large LVAs predict non-response to catheter ablation for PeAF, even with multiple ablation attempts.