A new clinical risk score for predicting the prevalence of low‐voltage areas in patients undergoing atrial fibrillation ablation

Abstract

Introduction: Although the presence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial fibrillation (AF) after ablation, few methods are available to classify the prevalence of LVAs. The purpose of this study was to establish a risk score for predicting the prevalence of LVAs in patients undergoing ablation for AF. Methods: We enrolled 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; female, 346 (34%); persistent AF, 513 (51%)). LVAs were deemed present when the voltage map after pulmonary vein isolation demonstrated low-voltage areas with a peak-to-peak bipolar voltage of <0.5 mV covering ≥5 cm 2 of the left atrium. Results: LVAs were present in 206 (21%) patients. The SPEED score was obtained as the total number of independent predictors as identified on multivariate analysis, namely female sex (odds ratio [OR], 3.4 [95% confidence interval {CI} 2.2-5.2], p < .01), persistent AF (OR, 1.8 [95% CI, 1.1-3.0], p = .02), age ≥ 70 years (OR, 2.3 [95% CI, 1.5-3.4], p < .01), elevated brain natriuretic peptide ≥100 pg/ml or N-terminal probrain natriuretic peptide ≥400 pg/ml (OR, 1.7 [95% CI, 1.02-2.8], p = .04), and diabetes mellitus (OR, 1.8 [95% CI, 1.1-2.8], p = .02). LVAs were more frequent in patients with a higher SPEED score, and prevalence increased with each additional SPEED score point (OR, 2.4 [95% CI, 2.0-2.8], p < .01). Conclusion: The SPEED score accurately predicts the prevalence of LVAs in patients undergoing ablation for AF.

Sex differences in atrial myocardial fibrosis and degeneration: evaluation using left atrial low-voltage areas during catheter ablation of atrial fibrillation

“…The higher prevalence of LVAs in women, which has been previously reported, 12,13 was confirmed across broad age and left atrial size groups. Several sex-specific pathophysiological features can be noted.…”

“…Women also had higher clinical scores predicting the presence of LVAs (SPEED and DR-FLASH). 11,12 On echocardiography, women patients had smaller atrial and ventricular chamber sizes, a higher left ventricular ejection fraction, and lower left ventricular mass.…”

“…These factors have been repeatedly reported in prior studies, and are well known to be associated with atrial myocardial degeneration. 12,[21][22][23][24][25] Notably, a history of heart failure and stroke/thromboembolic events has been associated with LVA existence specifically in men. Elevated atrial pressure in heart failure patients can advance atrial remodeling, and lead to atrial myocardial degeneration and LVA existence.…”

Electrical Remodeling of Left Atrium Is a Better Predictor for Recurrence Than Structural Remodeling in Atrial Fibrillation Patients Undergoing Radiofrequency Catheter Ablation

“…However, a recent study reported that the presence of LVZ can be predicted by pre-procedural markers (sex, age, diabetes, type of AF, brain natriuretic peptide). 28) Whether delayed gadolinium enhancement in cardiac magnetic resonance imaging correlates with LVZ acquired with electroanatomic mapping is another interesting area of future research.…”

Low atrial natriuretic peptide to brain natriuretic peptide ratio is associated with left atrial remodeling

“…[27][28][29] The ANP/BNP ratio was also compared based on the DR-FLASH score and SPEED score, which represent risk scores for predicting LVAs. 30,31 Kaplan-Meier analysis and the log-rank test were used to investigate the association between the longterm outcomes and the ANP/BNP ratio. In Kaplan-Meier analysis and the log-rank test, cut-off of the ANP/BNP ratio was set to the median value of 0.65.…”