Left atrial low voltage areas predicts clinical stroke after radiofrequency ablation in patients with atrial fibrillation
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Jianfan Shen1, Liqi Ge1, Lei Chen2
1Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China.
Insights
Low-voltage areas in the left atrium (LA) are linked to stroke risk after atrial fibrillation (AF) radiofrequency ablation (RFCA). Combining LA low-voltage area percentage (LA-LVA%) with CHA₂DS₂-VASc scores can identify patients at low risk for stroke.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Current anticoagulation for atrial fibrillation (AF) post-radiofrequency ablation (RFCA) relies on the CHA₂DS₂-VASc score, which has limited predictive accuracy.
- Left atrial (LA) substrate, specifically low-voltage areas (LVA), is implicated in thrombosis and atrial fibrosis.
- Limited research exists on the association between LA low-voltage areas and clinical stroke after RFCA.
Purpose of the Study:
- To investigate the association between left atrial low-voltage areas (LA-LVA%) and clinical stroke occurrence after RFCA in non-valvular AF (NVAF) patients.
- To evaluate the predictive value of LA-LVA% compared to the CHA₂DS₂-VASc score for postoperative stroke.
- To determine if combining LA-LVA% and CHA₂DS₂-VASc score can improve risk stratification.
Main Methods:
- A retrospective cohort study of 528 patients undergoing first-time AF RFCA.
- Intraoperative LA voltage mapping using an ablation catheter in sinus rhythm post-pulmonary vein isolation.
- Patients were followed for clinical stroke, divided into stroke-positive (n=31) and stroke-negative (n=497) groups.
Main Results:
- Low-voltage areas (LVA) were more prevalent in the stroke-positive group (58.0%) than the stroke-negative group (16.4%, p < 0.001).
- Multivariate analysis revealed CHA₂DS₂-VASc score (OR: 1.34), LA-LVA% (OR: 1.11), and left atrial diameter (LAD) (OR: 1.05) were correlated with stroke.
- In patients discontinuing anticoagulation, stroke rates differed significantly across risk groups defined by CHA₂DS₂-VASc and LA-LVA% (low-risk: 0.00%, intermediate-risk: 4.5%, high-risk: 27.3%).
Conclusions:
- Left atrial low-voltage area percentage (LA-LVA%) is significantly associated with clinical stroke after RFCA.
- The combination of CHA₂DS₂-VASc score and LA-LVA% effectively identifies low-risk patients.
- This combined approach may enhance risk stratification for stroke prevention post-AF ablation.
Background:
Current anticoagulation strategies of atrial fibrillation (AF) after radiofrequency ablation (RFCA) are still based on the CHA₂DS₂-VASc scoring system. The predictive value of the CHA2DS2-VASc score is limited and shows only moderate ability to assess risk.[1] Previous studies have shown that the left atrial substrate is associated with thrombosis.[2] Low-voltage areas(LVA) obtained in the left atrium (LA) are an accurate indicator to identify and measure atrial fibrosis. There are limited studies analyzing the association between low-voltage areas and clinical stroke post-RFCA.
Methods:
This retrospective cohort study included 528 patients with non-valvular atrial fibrillation (NVAF) who underwent first-time AF ablation. Intraoperative left atrial voltage mapping was completed using ablation catheter in sinus rhythm after circumferential pulmonary vein isolation (CPVI). Patients were followed up postoperatively and divided into stroke-positive (n = 31) and stroke-negative groups(n = 497) based on clinical stroke occurrence. The association between LA-LVA% and other clinical factors with postoperative clinical stroke was analyzed.
Results:
In the stroke-positive group, LVA was more prevalent than in the stroke-negative group [18/31 (58.0 %) vs. 82/497 (16.4 %), p < 0.001]. Multivariate logistic analysis showed a higher prevalence of CHA₂DS₂-VASc scores [OR: 1.34 95 % CI: (1.08-1.66), p = 0.008], LVA% [OR: 1.11 95 % CI: (1.02-1.20), p = 0.019] and LAD [OR: 1.05 95 % CI: (1.01-1.09), p = 0.010] were correlated with the occurrence of clinical stroke in patients after RFCA. In the patients who discontinued anticoagulation therapy (non-anticoagulation subgroup, n = 378), stratified analyses showed that the stroke rate in the low-risk group (0.00 %) was significantly lower than in the intermediate-risk group (4.5 %) and the high-risk group (27.3 %), with significant differences (p < 0.001).
Conclusions:
The LA-LVA% was significantly associated with postoperative clinical stroke. The combination of CHA₂DS₂-VASc score and LA-LVA% can identify low-risk patients.
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