Abstract 15913: The Extent of Low Voltage Left Atrial Areas Included in Wide Area Circumferential Pulmonary Vein Isolation is Associated With Freedom From Atrial Fibrillation
Introduction: It is known that the extent of low-voltage area (LVA) within the left atrium (LA) is associated with recurrent atrial fibrillation (AF) following ablation. However, the association of LVA extent included in wide area circumferential ablation (WACA) for pulmonary vein isolation (PVI) with freedom from AF is unclear.
Hypothesis: The extent of LVA included in WACA for PVI is associated with freedom from AF.
Methods: The study cohort included 159 consecutive patients with drug refractory AF that underwent an initial RF ablation with LA voltage mapping during sinus rhythm. The extent of LVAs included in WACA was quantified as a percentage of the entire LA surface area while excluding the LA appendage. Over a median follow up of 712 days (interquartile range 246-1207 days), surveillance and symptom prompted ECGs were performed to document AF recurrence.
Results: Of 159 patients, 28% were female, and 27% had persistent AF. The cohort was characterized by a mean age of 60.2±9.2 years, LA volume of 69.8±40.4 mL, and mean body mass index (BMI) of 29.0±5.7 kg/m2. Complete PVI was achieved in all patients. The mean number of sampled bipolar voltage points was 119±55.8. The mean LA surface area was 102.3±37.3 cm2, and the mean LVA was 1.9±3.8 cm2. The mean percentage of LVA included in WACA was 33.6±20.0%. In the multivariable cox proportional hazards model adjusted for LA volume, time since AF diagnosis, age, gender, BMI, and AF type, each 10% increase in LVA included in WACA was associated with 0.85 lower hazard of AF recurrence (P=0.014).
Conclusions: The LVA extent included in WACA is associated with freedom from AF following an initial ablation regardless of AF type. Routine voltage mapping and targeting of LVAs as an adjunct to PVI warrants further investigation.
Author Disclosures: D. Huang: None. J. Li: None. E.G. Ipek: None. T. Zghaib: None. M. Balouch: None. D.D. Spragg: None. H. Ashikaga: None. H. Tandri: None. S. Sinha: None. J.E. Marine: None. R.D. Berger: None. H. Calkins: None. S. Nazarian: None.
- © 2016 by American Heart Association, Inc.