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Left atrial deceleration outperforms regional conduction velocity in predicting arrhythmia recurrence following

Sophia Z Massin1, Nathan Denham1, Jayant Kakarla1

  • 1Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

Heart Rhythm O2
|July 30, 2025
PubMed

Insights

True deceleration (TD) better predicts atrial arrhythmia recurrence after pulmonary vein isolation (PVI) than slowest conduction velocity (CVmin). This novel metric quantifies left atrial remodeling and may improve substrate-based ablation success.

Area of Science:

  • Electrophysiology
  • Cardiology
  • Medical Imaging

Background:

  • Slowest regional conduction velocity (CVmin) is linked to atrial arrhythmia (AA) recurrence post-atrial fibrillation (AF) ablation.
  • The role of conduction deceleration in AF ablation outcomes remains under-investigated.

Purpose of the Study:

  • To evaluate true deceleration (TD) as a superior marker to CVmin for identifying abnormal left atrial (LA) substrate.
  • To assess TD's efficacy in predicting AA recurrence after de novo pulmonary vein isolation (PVI).

Main Methods:

  • Eighty AF patients and 6 controls underwent LA electroanatomic mapping during pacing.
  • Quantified regional low-voltage area (LVA), CVmin, and maximum true deceleration (TDmax).
  • TDmax was calculated as the largest continuous decline in CV along the wavefront.

Main Results:

  • TDmax weakly correlated with CVmin.
  • AF patients with AA recurrence exhibited larger LVA, lower CVmin, and greater TDmax.
  • Multivariate analysis showed TDmax (>110 m/s²) predicted recurrence (C-statistic = 0.74), outperforming CVmin (<0.2 m/s).

Conclusions:

  • True deceleration (TD) is a novel metric for quantifying LA remodeling and predicting AA recurrence post-PVI.
  • TD outperforms CVmin in predicting outcomes, suggesting its utility in substrate-based AF ablation.
  • This finding may inform future clinical trials aimed at enhancing ablation success rates.
Abstract

Keywords:
Atrial fibrillationAtrial myopathyCatheter ablationConduction velocityDecelerationLow-voltage areas

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