Catheter ablation of paroxysmal atrial fibrillation using high‐density mapping‐guided substrate modification

Abstract

Background: This study aimed to evaluate the effect of substrate modification in paroxysmal atrial fibrillation (AF) patients prior to circumferential pulmonary vein isolation (CPVI). Methods:Patients without left atrial low-voltage and/or scar areas were defined as Group A.Patients with left atrial low-voltage and/or scar areas underwent regular CPVI (Group B) or substrate modification after CPVI (Group C). The procedural success rate and differences in the left atrial diameter (LAD) among groups were compared at 1 year postoperatively. Results:The procedural success rate in Group C was comparable to that in Group A (P > 0.05) and was significantly higher than that in Group B (P < 0.01). The LAD of patients in Groups A and C significantly decreased at 1 year postoperatively compared to that prior to the surgery (P < 0.05).However, no significant difference was noted in Group B. Conclusions:Our study demonstrated that substrate modification could contribute to the single catheter ablation surgery success rate in patients with paroxysmal AF and narrow LAD. K E Y W O R D Shigh-density mapping, paroxysmal atrial fibrillation, radiofrequency catheter ablation, substrate modification 1630

Predictors of the voltage derived left atrial fibrosis in patients with long-standing persistent atrial fibrillation

“…Low-voltage areas (15 cm 2 ; 11% [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] of the TSA) were detected in 56% of the patients. Twenty nine percent of patients with LVA presented mild, 43% moderate and 28% severe global LVA voltage-derived LA remodeling and that the best predictors of LVA were female sex, CHA 2 DS 2 -VASc score > 4 and valvular heart disease.…”

“…According to available research, this is the first attempt to assess the incidence of voltage-derived LA fibrosis among a large unselected LSPAF population undergoing AF ablation and to correlate LVA burden with non--invasive pre-ablation parameters. Contemporary data concerning the incidence of voltage-defined LA remodeling describe paroxysmal [6][7][8][9], persistent [10][11][12][13][14][15][16] or a mixed AF population [4,5,[17][18][19][20][21][22][23][24][25][26][27] in which LSPAF patients are regularly underrepresented. Moreover, patients with severely enlarged atria, very long AF duration, who are elderly, with moderate valvular regurgitation or heart failure are commonly excluded [1,6,8,10,11,13,14,19,27].…”

“…In 3% of patients LVA were limited to 2 segments, and a single segment was affected in 29% (90% the posterior wall, 5% the anterior wall and 5% the inferior wall). The posterior wall was involved in 78.5% of cases (6 cm 2 [5][6][7][8][9][10][11][12][13]), the anterior LA in 52.3% (8 cm 2 [3][4][5][6][7][8][9][10][11][12]), the septum in 49.2% (8 cm 2 [3][4][5][6][7][8][9][10][11]), the inferior wall in 40% (8 cm 2 [4-10]), and the lateral LA in 23% [4.3 cm 2 [3][4][5][6][7][8]). The lateral LVA was only noted when there was already LVA elsewhere.…”

“…The underlying mechanism decreasing LA voltage is usually explained by tachycardia induced functional changes that over time result in electrical and structural atrial remodeling [28]. However other studies demonstrated LVA among the PAF population [1,4,[6][7][8][9][17][18][19][20][21][22][23]. It was also reported that even the successful elimination of AF fails to halt the progression of fibrosis [29], suggesting that abnormal LA substrate is not the result of arrhythmia alone.…”

A systematic review and meta-analysis of the safety and efficacy of left atrial substrate modification in atrial fibrillation patients with low voltage areas

“…We searched a total of 1,299 reports from all databases, and six studies (16,17,(19)(20)(21)(22) were finally included by excluding duplicates and browsing the abstracts and full text (Figure 1). Of these, two studies were retrospective studies, whose LVAsnon-ablation group was a historical control, three studies were prospective studies and one study was a randomized controlled study.…”