Left Atrial Electrophysiological Properties after Pulmonary Vein Isolation Predict the Recurrence of Atrial Fibrillation: A Cohort Study

Yunfei Gu; Hao Wang; Guohua Xue; Yubing Guo; Pengyu Wu; Jingchao He; Aolin Ding; Songsen Li; Gary Tse; Tong Liu

doi:10.31083/j.rcm2505167

Left Atrial Electrophysiological Properties after Pulmonary Vein Isolation Predict the Recurrence of Atrial Fibrillation: A Cohort Study

Rev Cardiovasc Med. 2024 May 13;25(5):167. doi: 10.31083/j.rcm2505167. eCollection 2024 May.

Authors

Yunfei Gu^{1

2}, Hao Wang², Guohua Xue², Yubing Guo², Pengyu Wu², Jingchao He², Aolin Ding³, Songsen Li², Gary Tse¹, Tong Liu¹

Affiliations

¹ Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, 300211 Tianjin, China.
² Department of Cardiology, Luoyang Central Hospital Affiliated to Zhengzhou University, 471000 Luoyang, Henan, China.
³ Biosense Webster Medical Technology, 471000 Luoyang, Henan, China.

Abstract

Background: The aim of this work was to investigate left atrial electrophysiological properties for their ability to predict the recurrence of atrial fibrillation (AF) following pulmonary vein isolation (PVI).

Methods: The study comprised 53 patients with AF [62 (interquartile range (IQR): 52-68) years old; 47.2% females]. High-density, three-dimensional electro-anatomic mapping using PentaRay was conducted during sinus rhythm in the left atrium (LA) immediately after PVI. LA conduction time, conduction velocity in predefined anterior and posterior routes, low voltage area percentage and distribution were assessed.

Results: The AF recurrence group had longer LA conduction time compared to the non-recurrence group [11 (IQR: 10-12) ms vs. 9 (IQR: 8-10) ms, p = 0.001). The percent low voltage area was greater in the recurrence group than the non-recurrence group [31.2 (IRQ: 7.1-49.3)% vs. 7.7 (IQR: 4.3-15.2)%, p = 0.008]. Multivariate Cox regression revealed that LA conduction time independently predicted AF recurrence following ablation over a median follow-up of 235 days [IQR: 154-382 days; hazard ratio (HR): 2.37, 95% confidence interval (CI): 1.08-5.23, p = 0.031]. The optimal cut-off for LA conduction time was 98 ms [area under curve (AUC): 0.926, sensitivity: 0.833, specificity: 0.894, p $<$ 0.01]. Kaplan-Meier analysis revealed that patients with a conduction time $>$ 98 ms had a higher rate of AF recurrence following ablation (p $<$ 0.001).

Conclusions: Patients with longer LA conduction time after PVI had more frequent AF recurrence.

Keywords: atrial fibrillation; left atrial conduction time; low voltage area; recurrence.

Grants and funding

Henan Province Key R&D and Promotion Project (No. 222102310076), Henan Provincial Science and Technology Research Project (No. LHGJ20220933), Luoyang Scientific and Technological Project (No. 2022021Y), Henan Province Key R&D and Promotion Project (No. 232300420247).