Slow whole left atrial conduction velocity after pulmonary vein isolation predicts atrial fibrillation recurrence

Abstract

BackgroundAtrial conduction velocity may represent atrial fibrillation (AF) substrate after pulmonary vein isolation (PVI). To elucidate the association between whole left atrial conduction velocity (LACV) and AF recurrence after PVI.Methods and ResultsThis observational study enrolled 279 patients (147 paroxysmal and 132 persistent AF) who underwent PVI alone as an initial AF ablation procedure. After PVI, the left atrium was mapped with a 20‐pole multielectrode in conjunction with the CARTO3 system during 100‐ppm right atrial pacing. Left atrial conduction distance and conduction time were calculated from the start to the end of the propagation wave front in the left atrium. LACVs on the anterior and posterior routes were calculated as conduction distance divided by conduction time. Anterior and posterior LACVs were slower in patients with AF recurrence than in those without (anterior, 0.79 [0.71, 0.86] vs 0.96 [0.90, 1.06] m/s, P < .001; posterior, 0.99 [0.89, 1.14] vs 1.10 [1.00, 1.29] m/s, P < .001). AF recurrence was best predicted by anterior LACV with a cut‐off value of 0.87 m/s (sensitivity 87%, specificity 81%, and predictive accuracy 84%). Multivariate analysis demonstrated that a slow anterior LACV <0.87 m/s was an independent predictor of AF recurrence with an adjusted hazard ratio of 11.8 (6.36‐22.0). Patients with anterior low‐voltage areas demonstrated slower anterior LACV than those without low‐voltage areas (0.89 [0.71, 1.00] vs 0.94 [0.87, 1.05] m/s, P < .001).ConclusionA slow anterior LACV was an excellent predictor of AF recurrence after PVI.

Left atrial localized low-voltage areas indicate whole left atrial electrophysiological degeneration in atrial fibrillation patients

“…In this and our previous study, 12 whole left atrial electrophysiological abnormalities such as an extensive mean regional voltage reduction and a slow left atrial total conduction velocity were shown to be reliable predictors of AF recurrence.…”

“…Left atrial conduction velocity was calculated as left atrial anterior conduction distance divided by conduction time between the start (septum) and end of the propagation wave front (lateral mitral annulus) in the left atrium, as reported previously. 12 Anterior conduction distance was measured manually by tracing the pathway of the propagation wave front from the start point to the end point in the anterior left atrium.…”

Reduced atrial conduction velocity is associated with the recurrence of atrial fibrillation after catheter ablation

“…During an invasive CA, the electrical properties can be directly evaluated. A recent paper has shown that a reduced conduction velocity in the LA is a predictor of AF recurrence after PVI [10]. In the present study, we evaluated the electrical properties in both atria in this study and revealed that the conduction velocity in the RA was also more reduced in the Rec group than in the non-Rec group.…”

Left Atrial Localized Low-Voltage Areas Indicate Whole Left Atrial Electrophysiological Degeneration in Atrial Fibrillation Patients

“…Mapping points were automatically acquired using the CARTO confidence module with the following settings: cycle length filtering, ±30 ms; localize activation time stability, <3 ms; position stability, <2 mm; as reported previously. 12 Anterior conduction distance was measured manually by tracing the pathway of the propagation wave front from the start point to the end point in the anterior LA. Associations between AF recurrence and mapping parameters representing whole LA electrophysiological degeneration were explored.…”

“…Following a blanking period of 3 months, they completed outpatient clinical visits and 12-lead ECG monitoring at 1, 3, 6 and 12 months, and 24 h-Holter by using the mean regional voltage at each region and LA total conduction velocity. 12 Mean regional voltage was calculated by averaging 10 points evenly selected across the region. 13 Receiver operating characteristic (ROC) analysis was used to estimate a best cut-off value of mean regional voltage to predict AF recurrence.…”