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Predictors of low voltage areas in persistent atrial fibrillation: is it really a matter of time?

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Time has been postulated as an important factor for electrical remodeling of the left atrium (LA) in persistent atrial fibrillation (AF) (‘AF begets AF’). However, it is still a matter of debate if structural changes are the cause or consequence of AF. We sought to determine the clinical and invasive parameters, which correlate with LA scar as determined by voltage mapping, in patients with persistent AF.

Methods

Seventy consecutive patients undergoing ablation of persistent (49%) or long-standing persistent AF (51%), between January 2013 and February 2014, were enrolled in the study. Besides clinical parameters, 2D echocardiographic assessment of LA size and LA pressure (LAP) after transseptal puncture was also considered. Bipolar endocardial signals with a mean voltage amplitude < 0.1 mV during AF were defined as LA scar.

Results

In the univariable analysis, LA scar was associated with age, gender, coronary artery disease (CAD), glomerular filtration rate (GFR), LA size and LAP. Arrhythmia duration, mild to moderate mitral regurgitation (MR), left ventricular dysfunction and left ventricular hypertrophy showed no significant correlation with atrial scar (all p > 0.05).

In a multivariable regression model, LA scar area was independently associated with age, female gender and LA area. AF duration was not associated with LA scar.

Conclusions

In this study, older age, greater LA area and female gender predicted the degree of LA scar, while other variables tested did not. In particular, we found no significant association between AF duration and LA scar.

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Author notes

  1. S. Ammar-Busch and A. Buiatti contributed equally to this work.

Authors and Affiliations

  1. Cardiology Department, Klinikum Coburg GmbH, Ketschendorfer Str. 33, 96450, Coburg, Germany

    S. Ammar-Busch

  2. Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany

    S. Ammar-Busch, A. Tatzber, T. Reents, F. Bourier, V. Semmler, M. Telishevska, G. Hessling & I. Deisenhofer

  3. Klinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    A. Buiatti

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  1. S. Ammar-Busch
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Contributions

S. Ammar-Busch: concept/design, data analysis/interpretation, drafting article, statistics, critical revision of article, approval of article.

A. Buiatti: concept/design, data analysis/interpretation, drafting article, approval of article, statistics.

A. Tatzber: data collection, statistics.

T. Reents: data analysis/interpretation, approval of article.

F. Bourier: data collection, approval of article.

V. Semmler: data collection, approval of article.

M. Telishevska: data collection, approval of article.

G. Hessling: critical revision of article, approval of article.

I. Deisenhofer: concept/design, critical revision of article, approval of article.

Corresponding author

Correspondence to S. Ammar-Busch.

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Ammar-Busch, S., Buiatti, A., Tatzber, A. et al. Predictors of low voltage areas in persistent atrial fibrillation: is it really a matter of time?. J Interv Card Electrophysiol 57, 345–352 (2020). https://doi.org/10.1007/s10840-018-0471-7

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  • DOI: https://doi.org/10.1007/s10840-018-0471-7

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