Korean Circ J.  2022 May;52(5):368-378. 10.4070/kcj.2021.0323.

Electrical Remodeling of Left Atrium Is a Better Predictor for Recurrence Than Structural Remodeling in Atrial Fibrillation Patients Undergoing Radiofrequency Catheter Ablation

• Kim YG
• Choi HY
• Shim J
• Min K
• Choi YY
• Choi JI
• Kim YH

• KMID: 2529868
• DOI: http://doi.org/10.4070/kcj.2021.0323

Abstract

Background and Objectives
Recurrence rates after radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients are not low especially in non-paroxysmal AF. The diameter of left atrium (LA) has been widely used to predict the recurrence after RFCA for decades. However, LA diameter represents structural remodeling of LA and does not reflect electrical remodeling. We aimed to determine the predictive value of electrical remodeling of LA which is represented by the amount of low voltage zone (LVZ).
Methods
We performed a retrospective cohort analysis of AF patients who underwent de novo RFCA in a single-center.
Results
A total of 3,120 AF patients with de novo RFCA were analyzed. Among these patients, 537 patients underwent an electroanatomic mapping with bipolar voltage measurement of LA. The diameter of LA and flow velocity of LA appendage (LAA) differed significantly according to quartile group of LVZ area and percentage: patients with high LVZ had large LA diameter and low LAA flow velocity (p<0.001). Freedom from late recurrence (LR) was significantly lower in patients with high LVZ area and percentage (p<0.001). The diameter and surface area of LA had area under curve (AUC) of 0.592 and 0.593, respectively (p=0.002 for both). The predictive value of LVZ area (AUC, 0.676) and percentage (AUC, 0.671) were both superior compared with LA diameter (p=0.011 and 0.027 for each comparison).
Conclusions
In conclusion, LVZ can predict freedom from LR after RFCA in AF patients. Predictive value was higher in parameters reflecting electrical rather than structural remodeling of LA.

Keyword

Atrial fibrillation; Catheter ablation; Recurrence

Figure

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  Figure 1 Flow of the study.LA = left atrium; LVZ = low voltage zone; RFCA = radiofrequency catheter ablation.

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  Figure 2 Association between LVZ and echocardiographic findings. (A) Difference in LA diameter according to LVZ area quartile. (B) Difference in LA diameter according to LVZ percentage quartile. (C) Difference in LAAFV according to LVZ area quartile. (D) Difference in LAAFV according to LVZ percentage quartile.LA = left atrium; LAAFV = left atrial flow velocity; LVZ = low voltage zone.

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  Figure 3 Impact of LVZ on LR. (A) Freedom from LR was significantly affected by LVZ area quartile. The p value for (i) group 1 vs. group 2=0.774; (ii) group 1 vs. group 3=0.001; (iii) group 1 vs. group 4<0.001; (iv) group 2 vs. group 3=0.004; (v) group 2 vs. group 4<0.001; (vi) group 3 vs. group 4=0.054. (B) Freedom from late recurrence LR was significantly affected by LVZ percentage quartile. The p value for (i) group 1 vs. group 2=0.567; (ii) group 1 vs. group 3<0.001; (iii) group 1 vs. group 4<0.001; (iv) group 2 vs. group 3<0.001; (v) group 2 vs. group 4<0.001; (vi) group 3 vs. group 4=0.318.LR = late recurrence; LVZ = low voltage zone.

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  Figure 4 Electrical remodeling vs. structural remodeling. (A) LA diameter and LA surface area showed similar predictive value for late recurrence. (B) LVZ area had significantly higher predictive value compared with LA diameter. (C) LVZ percentage had significantly higher predictive value compared with LA diameter.AUC = area under curve; LA = left atrium; LVZ = low voltage zone.

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