https://doi.org/10.1007/s00392-024-02526-y
1Medizinische Fakultät Carl Gustav Carus der TU Dresden Dresden, Deutschland; 2Herzzentrum Dresden GmbH an der TU Dresden Klinik für Innere Medizin und Kardiologie Dresden, Deutschland; 3Herzzentrum Dresden GmbH an der TU Dresden Klinik für Innere Medizin, Kardiologie und Intensivmedizin Dresden, Deutschland; 4Herzzentrum Dresden GmbH an der TU Dresden Rhythmologie Dresden, Deutschland; 5Herzzentrum Dresden GmbH an der TU Dresden Abteilung für Invasive Elektrophysiologie Dresden, Deutschland; 6Herzzentrum Dresden GmbH an der TU Dresden Sektion Rhythmologie Dresden, Deutschland
Background: The interventional management of persistent atrial fibrillation (pAF) remains challenging due to the limited evidence supporting adjunctive strategies beyond pulmonary vein isolation (PVI). A promising approach involves the ablation of left atrial low voltage zones (LVZ), which has demonstrated improved outcomes in pAF patients. This study aims to identify predictors for the presence of LVZ in the left atrium.
Methods: This retrospective, single-center study included 264 patients (31.8% female; mean age: 67 ± 10 years; mean AF duration: 1-2 years) diagnosed with pAF who underwent catheter ablation between January 2017 and January 2020. All patients underwent electrical cardioversion (CV) prior to ablation. If sinus rhythm (SR) was restored, high-density contact mapping was performed in SR before pulmonary vein isolation (PVI). In cases where initial cardioversion was unsuccessful, high-density contact mapping was performed after repeated CV following PVI.
Results: Among all patients, left atrial low voltage zones (LVZ) were identified in 98 out of 264 patients (37.1%). Multivariable analysis identified the following independent predictors for LVZ: age (OR = 1.069, 95% CI = 1.012-1.128, p = 0.016); diabetes (OR = 2.630, 95% CI = 1.120-6.174, p = 0.026); and NTproBNP (OR = 1.613, 95% CI = 1.029-2.530, p = 0.037).
Conclusion: About 40% of patients with pAF had left atrial low voltage zones (LVZ). Independent predictors of LVZ were advanced age, diabetes, and elevated NT-proBNP levels. These findings may potentially facilitate ablation strategy or technology selection, e.g., single-shot devices, prior to the procedure and improve the outcome of persistent fibrillation ablation procedures.