Impact of the extent of low-voltage zone on outcomes after voltage-based catheter ablation for persistent atrial fibrillation

Yamaguchi, Takanori; Tsuchiya, Takeshi; Fukui, Atsushi; Kawano, Yuki; Otsubo, Toyokazu; Takahashi, Yuya; Hirota, Kei; Murotani, Kenta; Eshima, Kenichi; Takahashi, Naohiko

doi:10.1016/j.jjcc.2018.04.010

Cited by 55 publications

(53 citation statements)

References 31 publications

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“…24,25 Many studies revealed that recurrence rate after AF ablation was significantly related with atrial fibrosis extent. [26][27][28][29][30] This fibrosis area might present as LVZs in endocardial recording. 8 Ablation strategy targeting these LVZs seems to be an effective way in AF ablation.…”

Section: Discussionmentioning

confidence: 98%

Role of sST2 in predicting recurrence of atrial fibrillation after radiofrequency catheter ablation

Liu

Wang

Lin

et al. 2020

Pacing Clinical Electrophis

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Introduction: Atrial fibrosis is associated with atrial fibrillation (AF) recurrence after ablation. This study aims to determine the relationship between soluble ST2 (sST2), a profibrotic biomarker, and AF recurrence after radiofrequency catheter ablation (RFCA). Methods: AF patients referred for RFCA were consecutively included from October 2017 to May 2019. Baseline characteristics were collected, and sST2 levels were determined before ablation. Left atrial substrate mapping was performed after circumferential pulmonary vein isolation under sinus rhythm, and substrate was modified in lowvoltage zones. A second procedure was recommended under recurrence. Results: Two hundred fifty-eight patients (146 males, average age 61.0 ± 8.8) were included. After a medium follow-up of 13.5 months, 52 patients (20.2%) had recurrence and received a second procedure. Preoperative sST2 level in patients with recurrence was significantly higher than that in patients without (31.3 ng/mL vs 20.3 ng/mL, P < .001). In those undergoing second ablation, sST2 level in patients with new abnormalities during endocardial mapping was significantly higher than that in patients without (43.0 ng/mL vs 22.1 ng/mL, P < .001). An sST2 level over 26.9 ng/mL could predict AF recurrence with new abnormalities during endocardial mapping with a sensitivity of 100% and a specificity of 75.9%. Multiple logistic analysis showed that sST2 level was an independent predictor of AF recurrence with new abnormalities during endocardial mapping (P < .001). Conclusions: sST2 level was associated with new abnormalities during endocardial mapping and recurrence of AF after ablation. It might have significance in choosing treatment strategies for AF.

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Section: Discussionmentioning

confidence: 98%

Role of sST2 in predicting recurrence of atrial fibrillation after radiofrequency catheter ablation

Liu

Wang

Lin

et al. 2020

Pacing Clinical Electrophis

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“…Low-voltage zones (LVZ) were arbitrarily defined as areas of a bipolar voltage of <0.5 mV, while silent areas (scars) translated into either no detection of electrical activity or a bipolar voltage of < 0.05 mV. Although several studies showed that patients presenting with increased LVZs (stages III and IV) present with increased post-ablation arrhythmic recurrences [44,46], there are several controversies regarding this technique.…”

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 99%

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

et al. 2020

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Left atrial structural, functional and electrical remodelling are linked to atrial fibrillation (AF) pathophysiology and mirror the phrase “AF begets AF”. A structurally remodelled left atrium (LA) is fibrotic, dysfunctional and enlarged. Fibrosis is the hallmark of LA structural remodelling and is associated with increased risk of stroke, heart failure development and/or progression and poorer catheter ablation outcomes with increased recurrence rates. Moreover, increased atrial fibrosis has been associated with higher rates of stroke even in sinus-rhythm individuals. As such, properly assessing the fibrotic atrial cardiomyopathy in AF patients becomes necessary. In this respect, late-gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard in imaging myocardial fibrosis. LA structural remodelling extension offers both diagnostic and prognostic information and influences therapeutic choices. LGE-CMR scans can be used before the procedure to better select candidates and to aid in choosing the ablation technique, during the procedure (full CMR-guided ablations) and after the ablation (to assess the ablation scar). This review focuses on imaging several LA structural remodelling CMR parameters, including size, shape and fibrosis (both extension and architecture) and their impact on procedure outcomes, recurrence risk, as well as their utility in relation to the index procedure timing.

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“…LVZs defined as < 0.5 mV during SR are identified about 30% in patients with persistent AF [18,36,37] and 15% in patients with paroxysmal AF [31] . We categorized patients into Stage I to Stage IV according to the extent of %LVZ ([ Figure 1]), and reported that LVZ extent is still a strong predictor for recurrence even after LVZ Four stages of left atrial (LA) low-voltage zone (LVZ).…”

Section: Spatial Distribution Of Lvz Lge and Fibrosismentioning

confidence: 99%

“…Total %LVZ area was calculated as the percentage of LA surface area excluding the PV antral region, LAA orifice, and mitral valve, and LVZ was subsequently categorized as stage I (<5%), II (≥5% to <20%), III (≥20% to <30%), and IV (≥30%) according to previous publication. [37] homogenization [37] . The spatial distribution of LVZs is related to the extent of LVZ.…”

Section: Spatial Distribution Of Lvz Lge and Fibrosismentioning

confidence: 99%

Bipolar Voltage Mapping for the Evaluation of Atrial Substrate: Can We Overcome the Challenge of Directionality?

Yamaguchi

Fukui

Node

2019

Journal of Atrial Fibrillation

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Accurate and reliable detection and quantification of atrial fibrosis could help to choose an appropriate strategy for treatment of AF. Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been developed to visualize and quantify extent of atrial fibrosis, [14,15] providing indirect evidence of fibrosis in the left atrium. Although significant advancements have been made in this technology, many significant controversies and limitations remain, including limited spatial resolution to detect fibrotic tissue in thin

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Impact of the extent of low-voltage zone on outcomes after voltage-based catheter ablation for persistent atrial fibrillation

Abstract: The extent of LVZ is an independent predictor for recurrence even after LVZ homogenization.

Cited by 55 publications

References 31 publications

Role of sST2 in predicting recurrence of atrial fibrillation after radiofrequency catheter ablation

Role of sST2 in predicting recurrence of atrial fibrillation after radiofrequency catheter ablation

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

Bipolar Voltage Mapping for the Evaluation of Atrial Substrate: Can We Overcome the Challenge of Directionality?

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