Association between left atrial low-voltage area and induction and recurrence of macroreentrant atrial tachycardia in pulmonary vein isolation for atrial fibrillation

Koichiro Sonoda; Tadatomo Fukushima; Asumi Takei; Kaishi Otsuka; Shiro Hata; Hiroki Shinboku; Takahiro Muroya; Koji Maemura

doi:10.1007/s10840-024-01760-8

Association between left atrial low-voltage area and induction and recurrence of macroreentrant atrial tachycardia in pulmonary vein isolation for atrial fibrillation

J Interv Card Electrophysiol. 2024 Feb 6. doi: 10.1007/s10840-024-01760-8. Online ahead of print.

Authors

Koichiro Sonoda¹, Tadatomo Fukushima², Asumi Takei³, Kaishi Otsuka², Shiro Hata², Hiroki Shinboku², Takahiro Muroya², Koji Maemura³

Affiliations

¹ Department of Cardiology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, 857-8511, Japan. ksonoq@yahoo.co.jp.
² Department of Cardiology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo, 857-8511, Japan.
³ Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.

PMID: 38321306
DOI: 10.1007/s10840-024-01760-8

Abstract

Background: The relationship between induction and recurrence due to atrial tachycardia (AT) and left atrial (LA) matrix progression after atrial fibrillation (AF) ablation remains unclear.

Methods: One hundred fifty-two consecutive patients with paroxysmal and persistent AF who underwent pulmonary vein isolation (PVI) and cavo-tricuspid isthmus (CTI) ablation and achieved sinus rhythm before the procedure were classified into three groups according to the AT pattern induced after the procedure: group N (non-induced), F (focal pattern), and M (macroreentrant pattern) in 3D mapping.

Results: The total rate of AT induction was 19.7% (30/152) in groups F (n = 13) and M (n = 17). Patients in group M were older than those in groups N and F, with higher CHADS₂/CHA₂DS₂-VASc values, left atrial enlargement, and low-voltage area (LVA) size of LA. The receiver operating characteristic curve determined that the cut-off LVA for macroreentrant AT induction was 8.8 cm² (area under the curve [AUC]: 0.86, 95% confidence interval [CI]: 0.75-0.97). The recurrence of AT at 36 months in group N was 4.1% (5/122), and at the second ablation, all patients had macroreentrant AT. Patients with AT recurrence in group N had a wide LVA at the first ablation, and the cut-off LVA for AT recurrence was 6.5 cm² (AUC 0.94, 95%CI 0.88-0.99). Adjusted multivariate analysis showed that only LVA size was associated with the recurrence of macroreentrant AT (odds ratio 1.21, 95%CI 1.04-1.51).

Conclusions: It is important to develop a therapeutic strategy based on the LVA size to suppress the recurrence of AT in these patients.

Keywords: 3D mapping; Atrial fibrillation ablation; Atrial remodeling; Atrial tachycardia; Low-voltage area.