Presence and predictors of atrial low voltage zones in patients with non cardiovertable atrial fibrillation

• DOI: 10.1093/europace/euae102.067
• Publication Date: 2024-05-24T12:19:19Z
• Authors: I Bergt; S R Richter; M E Ebert; J M Mayer; A Z Zedda; S U Ulbrich; Z D Dindane; U R Richter; T G Gaspar
• Keywords: P wave; Atrium (architecture); Atrial tachycardia

Abstract Background Interventional treatment of persistent atrial fibrillation (pAF) presents a challenge due to the lack clear evidence on adjunctive strategies beyond pulmonary vein isolation (PVI). One promising approach is ablation left low voltage zones, which has been shown improve outcomes in patients with pAF. However, reliable assessment endocardial requires sinus rhythm (SR). In significant proportion however, restoration (SR) cannot be achieved. These may lead extensive ablations such as defragmentation or empirical posterior wall atrium. This study aims investigate potential unsuccessful cardioversion prior predictor for presence zones (LVZ) Methods retrospective, single-centre was conducted 264 (31,8% female; age: 67±10 years; mean AF duration: 1-2 years) diagnosed pAF who underwent catheter between 01/2017 and 01/2020. All electrical (CV) before ablation. If SR achieved, high-density contact mapping performed (PVI), case initial cardioversion, after repeated CV followed PVI, respectively. Results Initial 53 out (19.7%) patients. Subsequent isolation, successful 47 (81%) initially considered non-cardiovertible. 32 (60.4%) had an no identified. Amongst were apparent 77 211 (36.5%). There difference (χ²(1) = 0.178, p 0.673, φ 0.026). According ROC analysis, success does not have any predictive value LVZ (AUC 0.511). Conclusion Cardioversion failure predict low-voltage (LVZ). PVI alone adequate even patient clinically "end stage" non-cardiovertible fibrillation. Ablation overtreat this specific group, resulting increase secondary arrhythmias. findings indicate that single-shot devices balloon-based techniques considerable strategy these cohort.