Baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: WAVE-MAP AF results

• Published in: Europace (London, England) Vol. 25; no. 9
• Main Authors: Starek, Zdenek, Di Cori, Andrea, Betts, Timothy R, Clerici, Gael, Gras, Daniel, Lyan, Evgeny, Della Bella, Paolo, Li, Jingyun, Hack, Benjamin, Zitella Verbick, Laura, Sommer, Philipp
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 02.08.2023
• Subjects: Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Atrial Flutter - diagnosis; Atrial Flutter - etiology; Atrial Flutter - surgery; Catheter Ablation - adverse effects; Catheter Ablation - methods; Clinical Research; Electrophysiologic Techniques, Cardiac; Heart Atria; Heart Rate; Humans; Pulmonary Veins - surgery; Recurrence; Time Factors; Treatment Outcome; Low-voltage area; Atrial fibrillation; Catheter ablation; Electroanatomic mapping; Pulmonary vein isolation
• ISSN: 1099-5129; 1532-2092; 1532-2092
• DOI: 10.1093/europace/euad194

Abstract Aims Electro-anatomical mapping may be critical to identify atrial fibrillation (AF) subjects who require substrate modification beyond pulmonary vein isolation (PVI). The objective was to determine correlations between pre-ablation mapping characteristics and 12-month outcomes after a single PVI-only catheter ablation of AF. Methods and results This study enrolled paroxysmal AF (PAF), early persistent AF (PsAF; 7 days–3 months), and non-early PsAF (>3–12 months) subjects undergoing de novo PVI-only radiofrequency catheter ablation. Sinus rhythm (SR) and AF voltage maps were created with the Advisor HD Grid™ Mapping Catheter, Sensor Enabled™ for each subject, and the presence of low-voltage area (LVA) (low-voltage cutoffs: 0.1–1.5 mV) was investigated. Follow-up visits were at 3, 6, and 12 months, with a 24-h Holter monitor at 12 months. A Cox proportional hazards model identified associations between mapping data and 12-month recurrence after a single PVI procedure. The study enrolled 300 subjects (113 PAF, 86 early PsAF, and 101 non-early PsAF) at 18 centres. At 12 months, 75.5% of subjects were free from AF/atrial flutter (AFL)/atrial tachycardia (AT) recurrence. Univariate analysis found that arrhythmia recurrence did not correlate with AF diagnosis, but LVA was significantly correlated. Low-voltage area (<0.5 mV) >28% of the left atrium in SR [hazard ratio (HR): 4.82, 95% confidence interval (CI): 2.08–11.18; P = 0.0003] and >72% in AF (HR: 5.66, 95% CI: 2.34–13.69; P = 0.0001) was associated with a higher risk of AF/AFL/AT recurrence at 12 months. Conclusion Larger extension of LVA was associated with an increased risk of arrhythmia recurrence. These subjects may benefit from substrate modification beyond PVI. Graphical Abstract Graphical Abstract