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Baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: WAVE-MAP AF results
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-o...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410193/ https://www.ncbi.nlm.nih.gov/pubmed/37470443 http://dx.doi.org/10.1093/europace/euad194 |
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author | 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 |
author_facet | 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 |
author_sort | Starek, Zdenek |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10410193 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-104101932023-08-10 Baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: WAVE-MAP AF results 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 Europace Clinical Research 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. Oxford University Press 2023-07-20 /pmc/articles/PMC10410193/ /pubmed/37470443 http://dx.doi.org/10.1093/europace/euad194 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Research 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 Baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: WAVE-MAP AF results |
title | Baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: WAVE-MAP AF results |
title_full | Baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: WAVE-MAP AF results |
title_fullStr | Baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: WAVE-MAP AF results |
title_full_unstemmed | Baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: WAVE-MAP AF results |
title_short | Baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: WAVE-MAP AF results |
title_sort | baseline left atrial low-voltage area predicts recurrence after pulmonary vein isolation: wave-map af results |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410193/ https://www.ncbi.nlm.nih.gov/pubmed/37470443 http://dx.doi.org/10.1093/europace/euad194 |
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