Abstract 15 Left atrial fibrosis and voltage amplitude as predictors of atrial fibrillation recurrence after PVI

Background:

The left atrial (LA) substrate plays a significant role in both the initiation and maintenance of atrial fibrillation (AF). This study aims to precisely estimate the extent of LA fibrosis identified in electroanatomical mapping (EAM) models and explore its correlation with AF recurrence following repeat pulmonary vein isolation (PVI) in patients with a history of unsuccessful PVI.

Methods:

A total of 91 patients were enrolled, who had presented for a redo PVI procedure after experiencing AF recurrence following a previous PVI. Ablation was performed on all patients using the Biosense Webster CARTO mapping system and a high definition (HD) mapping catheter. The minimum number of electroanatomical points was set at 1500. Reconnected pulmonary veins were detected in all patients and were re-isolated. The true left atrial surface area was then calculated by removing the pulmonary veins, mitral valve, and left atrial appendage in order to accurately determine the percentage of LA fibrosis in relation to the LA surface using the CARTO surface tool. The median follow-up duration was 15 months.

Results:

LA fibrosis burden exceeding 40% was found to be significantly associated with the outcome of pulmonary vein isolation (PVI) (HR=4.9, 95% CI 1.1-21.0, p=0.031). Additionally, an average LA voltage amplitude below 0.7 mV was identified as a predictor of AF recurrence, even after adjusting for age, sex, and AF type (HR=0.641, 95% CI 0.430-0.985, p=0.030). while the percentage of LA fibrosis was observed to be associated with the type of AF, the type of AF was not associated with the recurrence of AF.

Conclusion:

Left atrial fibrosis extent is an important predictor of AF recurrence regardless of AF type. These findings highlight the importance of accurately estimating the extent of LA fibrosis using electroanatomical mapping (EAM) models in predicting AF recurrence and guiding treatment decisions.

Figure1. EAM model of LA before & after editing.

Figure 2.The resulting areas were also excluded.

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02302-4
Left atrial fibrosis and voltage amplitude as predictors of atrial fibrillation recurrence after PVI
Y. Mohsen¹, M. Horlitz¹, F. Stöckigt¹
¹Klinik für Kardiologie, Elektrophysiologie u. Rhythmologie, Krankenhaus Porz am Rhein gGmbH, Köln;
Background: The left atrial (LA) substrate plays a significant role in both the initiation and maintenance of atrial fibrillation (AF). This study aims to precisely estimate the extent of LA fibrosis identified in electroanatomical mapping (EAM) models and explore its correlation with AF recurrence following repeat pulmonary vein isolation (PVI) in patients with a history of unsuccessful PVI. Methods: A total of 91 patients were enrolled, who had presented for a redo PVI procedure after experiencing AF recurrence following a previous PVI. Ablation was performed on all patients using the Biosense Webster CARTO mapping system and a high definition (HD) mapping catheter. The minimum number of electroanatomical points was set at 1500. Reconnected pulmonary veins were detected in all patients and were re-isolated. The true left atrial surface area was then calculated by removing the pulmonary veins, mitral valve, and left atrial appendage in order to accurately determine the percentage of LA fibrosis in relation to the LA surface using the CARTO surface tool. The median follow-up duration was 15 months. Results: LA fibrosis burden exceeding 40% was found to be significantly associated with the outcome of pulmonary vein isolation (PVI) (HR=4.9, 95% CI 1.1-21.0, p=0.031). Additionally, an average LA voltage amplitude below 0.7 mV was identified as a predictor of AF recurrence, even after adjusting for age, sex, and AF type (HR=0.641, 95% CI 0.430-0.985, p=0.030). while the percentage of LA fibrosis was observed to be associated with the type of AF, the type of AF was not associated with the recurrence of AF. Conclusion: Left atrial fibrosis extent is an important predictor of AF recurrence regardless of AF type. These findings highlight the importance of accurately estimating the extent of LA fibrosis using electroanatomical mapping (EAM) models in predicting AF recurrence and guiding treatment decisions. Figure1. EAM model of LA before & after editing. Figure 2.The resulting areas were also excluded.
https://dgk.org/kongress_programme/ht2023/aP567.html