Low Voltage Areas in the Left Atrium After Sole Pulmonary Vein Isolation as a Predictor of Atrial Fibrillation Recurrence—Based on Sequential Voltage Map Analysis Using High-Density Mapping Catheters

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology Pub Date : 2026-10-13 Epub Date: 2026-08-20 DOI:10.1111/jce.70463

Satoshi Hara, Shigeki Kusa, Naoyuki Miwa, Yoshikazu Sato, Tadanori Nakata, Taiki Ishizawa, Tetsuo Sasano, Hitoshi Hachiya

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引用次数: 0

Abstract

Background

Low-voltage areas (LVA) in the left atrium (LA) have been linked to atrial fibrillation (AF) recurrence. However, prior studies lacked high-density mapping catheter (HMDC) mapping, included non-pulmonary vein isolation (PVI) ablation strategies, and did not follow temporal progression of LVA in individuals.

Methods and Results

We retrospectively analyzed 1661 AF patients who had undergone initial ablation using PVI alone, and in whom voltage maps of the LA had been created with HDMCs. We investigated the relationship between LVA size (Small-LVA group: LVA < 5 cm² and Extensive-LVA group: LVA ≥ 5 cm²) and AF recurrence. HDMCs were again used to map the LA at the time of the re-do ablation. A total of 711 patients met our inclusion criteria (Small-LVA 554, Extensive-LVA 157). During the mean follow-up period of 643.6 ± 490.5 days, 21% of Small-LVA patients (n = 117) and 33% of Extensive-LVA patients (n = 52) experienced recurrence (p < 0.005), of whom 106 (63%) underwent redo ablation. Belonging to the Extensive-LVA group was predictive of AF recurrence both after the initial ablation and after the redo ablation. They also exhibited greater non–PV related recurrence. Time-dependent progression of LVA was observed in 32 patients with a mean increase of 4.7 ± 5.1 cm² and was significantly more frequent in the Extensive-LVA group. This progression was not linked to AF recurrence.

Conclusion

We used high-density mapping to evaluate left atrial LVA in patients who had only received PVI, and demonstrated LVA influence on AF recurrence and recurrence patterns.

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单肺静脉隔离后左心房低压区作为房颤复发的预测因子——基于高密度测图导管的序贯电压图分析

背景：左心房（LA）低压区（LVA）与房颤（AF）复发有关。然而，先前的研究缺乏高密度定位导管（HMDC）定位，包括非肺静脉隔离（PVI）消融策略，并且没有跟踪个体LVA的时间进展。方法和结果：我们回顾性分析了1661例单独使用PVI进行初始消融的房颤患者，这些患者使用hdmc创建了LA电压图。我们研究了LVA大小（小LVA组：LVA 2，大LVA组：LVA≥5 cm2）与房颤复发的关系。在再次消融时再次使用hdmc来绘制LA。共有711例患者符合我们的纳入标准（Small-LVA 554, Extensive-LVA 157）。在平均随访643.6±490.5 d期间，21%的小lva患者（n = 117）和33%的大lva患者（n = 52）出现复发（p < 2），且大lva组复发频率明显高于大lva组。这一进展与房颤复发无关。结论：我们采用高密度测绘技术评估仅行PVI的患者左房LVA，并证实LVA对房颤复发及复发模式的影响。

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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来源期刊

Journal of Cardiovascular Electrophysiology 医学-心血管系统

CiteScore

5.20

自引率

14.80%

发文量

433

审稿时长

3-6 weeks

期刊介绍： Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.