Left atrial wall thickness is associated with the low-voltage area in patients with paroxysmal atrial fibrillation
- 19 Downloads
To identify a potential morphological marker of remodeling and electrophysiological dysfunction, we investigated if low wall thickness is associated with low-voltage areas (LVAs) in the left atrium.
Wall thickness was measured by computed tomography and LVA (% area with bipolar voltage < 0.5 mV) by voltage mapping in 43 paroxysmal AF patients. The left atrium was divided into five segments: septal wall, anterior wall, roof wall, posterior wall, and bottom wall in regional analysis.
Left atrial wall thickness and LVA were 3.2 ± 0.6 mm and 14% ± 9%, respectively. Multivariate analysis identified left atrial wall thickness and volume as independent determinants of left atrial LVA (thickness, standardized β − 0.374, 95%CI − 23.289 to − 4.534, P = 0.005; volume, standardized β 0.452, 95%CI 0.049–0.214, P = 0.002). In regional analysis, significant LVA (> 10% of segment surface area) was observed in 123 of 215 segments (57%). Segments in the low tertile of wall thickness (< 1.76 mm) had larger LVAs compared with segments in middle (1.76–2.14 mm) and high tertiles (≥ 2.14 mm) (low tertile, 20.3% ± 14.9%; middle tertile, 12.6% ± 11.2%; high tertile, 12.5% ± 12.1%; low vs. middle tertile, P = 0.001; low vs. high tertile, P = 0.001). Area under the receiver operating curve of wall thickness was 0.706 for prediction of significant LVA. A thickness cut-off of 1.90 mm yielded 62% sensitivity, 73% specificity, 75% positive predictive value, and 59% negative predictive value for significant LVA.
A thin left atrial wall is an independent predictor of LVA in patients with paroxysmal AF.
KeywordsAtrial fibrillation Atrial remodeling Atrial wall thickness Low-voltage area Voltage mapping Left atrium
The authors thank Mr. Yasushi Terada and Mr. Norihiko Konishi for their technical assistance.
Compliance with ethical standards
The study protocol was approved by the Institutional Research and Ethics Committee of University of Toyama (Toyama, Japan) and adhered to the principles of the Declaration of Helsinki. We obtained written informed consent from all patients before performing catheter ablation.
- 4.Nakatani Y, Sakamoto T, Yamaguchi Y, Tsujino Y, Kataoka N, Kinugawa K. P-wave vector magnitude predicts recurrence of atrial fibrillation after catheter ablation in patients with persistent atrial fibrillation. Ann Noninvasive Electrocardiol. 2019.Google Scholar
- 6.Whitaker J, Rajani R, Chubb H, Gabrawi M, Varela M, Wright M, et al. The role of myocardial wall thickness in atrial arrhythmogenesis. Europace. 2016;18:1758–72.Google Scholar
- 7.Nakamura K, Funabashi N, Uehara M, Ueda M, Murayama T, Takaoka H, et al. Left atrial wall thickness in paroxysmal atrial fibrillation by multislice-CT is initial marker of structural remodeling and predictor of transition from paroxysmal to chronic form. Int J Cardiol. 2011;148:139–47.CrossRefGoogle Scholar
- 10.Takahashi K, Okumura Y, Watanabe I, Nagashima K, Sonoda K, Sasaki N, et al. Relation between left atrial wall thickness in patients with atrial fibrillation and intracardiac electrogram characteristics and ATP-provoked dormant pulmonary vein conduction. J Cardiovasc Electrophysiol. 2015;26:597–605.CrossRefGoogle Scholar
- 22.Park J, Joung B, Uhm JS, Young Shim C, Hwang C, Hyoung Lee M, et al. High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation. Heart Rhythm. 2014;11:953–60.CrossRefGoogle Scholar
- 24.Rodríguez-Mañero M, Valderrábano M, Baluja A, Kreidieh O, Martínez-Sande JL, García-Seara J, et al. Validating left atrial low voltage areas during atrial fibrillation and atrial flutter using multielectrode automated electroanatomic mapping. JACC Clin Electrophysiol. 2018;4:1541–52.CrossRefGoogle Scholar
- 26.Jadidi AS, Lehrmann H, Keyl C, Sorrel J, Markstein V, Minners J, et al. Ablation of persistent atrial fibrillation targeting low-voltage areas with selective activation characteristics. Circ Arrhythm Electrophysiol. 2016;9:e002962.Google Scholar