Left atrial remodeling and voltage-guided ablation outcome in persistent atrial fibrillation patients over 75 years of age

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-03-01 DOI:10.1016/j.hroo.2024.12.006

Halim Marzak MD , Clément Baldacini MD , François Severac MD , Simon Fitouchi MD , Thomas Cardi MD , Mohamad Kanso MD , Alexandre Schatz MD , Patrick Ohlmann MD, PhD , Olivier Morel MD, PhD , Laurence Jesel MD, PhD

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Abstract

Background

The prevalence of atrial fibrillation (AF) increases with age. The improvement in ablation techniques has widened the indications, particularly in elderly patients. Data on LA remodeling and low-voltage zone (LVZ) extent in this subgroup are scarce.

Objective

We assessed the left atrial (LA) bipolar voltage, LVZ extent, and efficacy of voltage-guided ablation in a cohort of patients with persistent AF according to age.

Methods

Three hundred fifty-three patients with persistent AF undergoing a first voltage-guided ablation procedure were enrolled and divided into 2 groups: those <75 years of age (n=286) and those ≥75 years of age (n=67). LA voltage maps were obtained in sinus rhythm. LVZ was defined as <0.5 mV. A propensity score–matching analysis was used to assess the impact of age on LA remodeling.

Results

The LA bipolar voltage was lower (P<.01) in elderly patients. LVZs were found in 67% of elderly patients and 30% of younger patients (P<.01), especially in mild (P<.01) and moderate (P<.01) LVZs. After propensity score matching, these differences were no longer noticeable. Pulmonary vein isolation alone was performed in 33% of elderly patients and 70% of patients <75 years of age (P<.01). Female sex (P<.001), age ≥ 75 years (P=.042), estimated glomerular filtration rate (P=.009), and LA volume index (P<.001) were predictive of LVZ presence. After 36 months of follow-up, the AF-free survival rate after a single procedure was similar between the 2 groups.

Conclusion

Patients >75 years of age with persistent AF display increased LA substrate remodeling than do younger patients. LA scar did not seem to negatively affect the results of substrate-guided ablation, and the complication rate was low.

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75岁以上持续性心房颤动患者左房重构和电压引导消融的结果

背景：心房颤动（AF）的患病率随着年龄的增长而增加。消融技术的改进扩大了适应症，特别是在老年患者中。关于该亚群的LA重塑和低压区（LVZ）范围的资料很少。目的：对一组年龄不同的持续性房颤患者进行左心房双极电压、LVZ范围和电压引导消融的疗效评估。方法纳入353例首次行电压引导消融术的持续性房颤患者，分为2组：75岁组（n=286）和≥75岁组（n=67）。获得窦性心律时的LA电压图。LVZ定义为<；0.5 mV。使用倾向评分匹配分析来评估年龄对LA重塑的影响。结果老年患者LA双极电压较低（p < 0.01）。67%的老年患者和30%的年轻患者存在lvz (P<.01)，其中以轻度（P<.01）和中度（P<.01） lvz最为明显。在倾向得分匹配后，这些差异不再明显。33%的老年患者和70%的75岁患者单独进行了肺静脉隔离（p < 0.01）。女性（P= 0.001）、年龄≥75岁（P= 0.042）、估计肾小球滤过率（P= 0.009）和LA容积指数（P= 0.001）是LVZ存在的预测因素。随访36个月后，两组单次手术后无af生存率相近。结论75岁持续性房颤患者LA底物重构明显高于年轻患者。LA瘢痕似乎没有负面影响底物引导消融的结果，并发症发生率低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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