Purpose: The current study aims to identify the LA voltage marker with the highest predictive value with regard to arrhythmia recurrence in AF patients undergoing de-novo circumferential pulmonary vein isolation (CPVI).
Methods: 278 patients (36% female, 55% persistent AF) undergoing de-novo CPVI were enrolled in the study. High-density electro-anatomical mapping was performed strictly under sinus rhythm (SR) to determine the following parameters GMV, LVA, left atrial volume (LAV). All three parameters were extracted and quantified using an AI-algorithm developed by Karlsruhe Institute of Technology. Arrhythmia recurrence included occurrence of AF, atrial flutter and atrial tachycardia at 6-, 12- and 24-month FU respectively.
Results: Arrhythmia recurrence occurred in 48 (17.3%) patients within 12-month FU and in 83 patients (29.9%) within 24-month FU. Multivariate COX regression identified persistent AF and LVA at 1.0mV threshold (continuous variable) as the only two significant predictors for arrhythmia recurrence at both 12-month FU (Persistent AF: HR=2.11, p=0.027; LVA: HR=1.02, p=0.034) and 24-month FU (Persistent AF: HR=1.84, p=0.013; LVA: HR=1.02, p=0.003). C-statistics identified the cut-off thresholds of LVA of >1.5cm2 and >3.0cm2 for paroxysmal and persistent AF cohorts, respectively. As a result, LVA >1.5 cm in paroxysmal cohort was associated with significant difference in arrhythmia freedom rate at 12-month (97.8% vs. 87.6%, p=0.015) and marginally significant difference at 24-month (82.7% vs. 67.6%, p=0.051). LVA >3.0cm2 in persistent cohort was associated with significant difference in arrhythmia freedom rate at both 12-month (89.2% vs. 68.5%, p=0.008) and 24-month (72.5% vs. 43.2%, p=0.002).
Conclusion: Persistent AF and LVA at 1.0mV bipolar threshold in sinus map are highly predictive of arrhythmia recurrence after CPVI, however, more robust predictive performance is observed in persistent cohorts.
