Long-term results of pulmonary vein antrum isolation in patients with atrial fibrillation: an analysis in regards to substrates and pulmonary vein reconnections

Yamaguchi, Takanori; Tsuchiya, Takeshi; Nagamoto, Yasutsugu; Miyamoto, Koji; Murotani, Kenta; Okishige, Kaoru; Takahashi, Naohiko

doi:10.1093/europace/eut265

Cited by 50 publications

(56 citation statements)

References 30 publications

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“…Low‐voltage electrograms are mainly due to atrial fibrosis, and the extent of fibrosis correlates with persistence of AF . In addition, an increased amount of fibrosis in the LA is strongly related to AF recurrence after AF ablation . Fibrotic remodeling tissue acts as an AF substrate because it exhibits slow conduction and short action potential duration, which facilitates reentry .…”

Section: Discussionmentioning

confidence: 99%

“…PVI was performed as previously described . Briefly, ablation of the ipsilateral superior and inferior PVs was performed simultaneously with a continuous lesion around the antral region of the ipsilateral superior and inferior PVs using the open‐irrigation catheter through the SL0 TM or Agilis TM sheath.…”

Section: Methodsmentioning

confidence: 99%

“…Low‐voltage zones (LVZs), identified during sinus rhythm (SR) with an electroanatomical mapping system, accurately represent the presence of fibrotic tissue, and the existence and extent of fibrotic tissue in the LA predict the success rate after AF ablation, unless such fibrotic tissue is left untreated . We have previously reported that the AF free‐survival rate after PVI alone was much lower in patients with LVZs than in those without LVZs . Although recent evidence has shown positive results with LVZ ablation, knowledge regarding low‐voltage–guided substrate modification is still limited.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of Left Atrial Voltage‐Based Catheter Ablation of Persistent Atrial Fibrillation

Yamaguchi

Tsuchiya²,

Nakahara

et al. 2016

Cardiovasc electrophysiol

161

191

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Left Atrial Voltage‐Based Catheter Ablation of Persistent Atrial Fibrillation

Yamaguchi

Tsuchiya²,

Nakahara

et al. 2016

Cardiovasc electrophysiol

161

191

View full text Add to dashboard Cite

show abstract

“…Low voltage in the left atrium, consistent with pre-existent scarring, has been shown to be a powerful predictor of procedural failure in patients undergoing PVI for AF 7,8) . Recent studies have shown that, in comparison to conventional PVI, PVI with the addition of voltage-guided substrate modification achieved by targeting the lowvoltage area is more effective, is safer, and leads to lower proarrhythmic potential [9][10][11][12][13] .…”

Section: La Voltages During Sr and Afmentioning

confidence: 99%

“…A recent study, however, showed no reduction in the AF recurrence rate when either ablation of CFAEs or linear ablation was performed in addition to PVI in patients with PerAF 6) . Pre-existent left atrial (LA) scars indicated by low-voltage zones (LVZs) on 3-dimensional (3D) electroanatomic maps are implicated in suboptimum ablation outcomes 7,8) , and success has been achieved in patients with PerAF when, in addition to PVI, the atrial substrate has been modified by ablation of low-voltage areas detected during sinus rhythm (SR) [9][10][11][12][13] . Slight differences exist between the definitions of such low-voltage zones (LVZs), which are described variously as areas of bipolar voltage of < 0.4 mV ~ < 0.5 mV, depending on the group of investigators [14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Predicting Left Atrial Low-Voltage Areas During Sinus Rhythm on the Basis of Low Voltage During Atrial Fibrillation

Takahashi

Watanabe

Okumura

et al. 2018

Nichidai Igaku Zasshi

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Background: As we have found a significant correlation between left atrial (LA) voltage during sinus rhythm (SR) and that during atrial fibrillation (AF), we hypothesized that the existence of low-voltage zones (LVZs) during AF can be used to identify LVZs during SR. Therefore, we conducted a study to test this hypothesis.Methods: In 8 patients, high-density bipolar voltage mapping (> 300 points) of the left atrium was performed with a 20-pole circular catheter with 4-4-4-mm interelectrode spacing. The left atrium was divided into 7 segments, and the mean LA bipolar voltages recorded over 5 seconds during SR and AF were determined by measurement of the peak-to-peak amplitudes.Results: LVZs identified at each segment were compared between SR and AF. LA bipolar voltages obtained during SR and AF correlated positively (r = 0.74, p < 0.0001). With the low voltage during SR defined as < 0.5 mV, the low voltage of < 0.2 mV during AF approximately matched the low LVZs mapped during SR.Conclusions: These findings indicate that LVZs of < 0.5 mV during SR could be predicted from LVZs identified during AF by designating a threshold AF voltage of 0.2 mV.

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The impact of the presence of left atrial low voltage areas on outcomes from pulmonary vein isolation

Ahmed-Jushuf

Murgatroyd

Dhillon

et al. 2019

Journal of Arrhythmia

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Background AF ablation ( AFA ) with pulmonary vein isolation ( PVI ) is highly successful for paroxysmal atrial fibrillation ( PAF ). However, success rates for persistent AF (Ps AF ) are significantly lower. In this study we evaluate the impact of left atrial ( LA ) low voltage areas ( LVA ) on response to AFA . Methods Consecutive patients undergoing first‐time radiofrequency AFA were included (n = 160, 53% PAF ). PVI was performed followed by LA voltage mapping during sinus rhythm. Patients were categorized as having LVA based on the presence of LVA (0.2‐0.5 mV) in the LA assessed visually by the operator intra‐procedurally. Further adjunctive LA ablation was performed at the operators’ discretion. The end‐point was recurrence of any sustained atrial arrhythmia (atrial fibrillation/tachycardia/flutter) during 12 months follow‐up. Results All patients had PVI and 23 (14%) had adjunctive LA ablation. LVA were found in 49 (31%) patients and were an independent predictor of arrhythmia recurrence. Patients with LVA compared to those without had significantly lower 12‐month arrhythmia‐free survival in both PAF (38% vs 76%; P = 0.002) and Ps AF (27% vs 61%; P = 0.015). Ps AF patients without LVA (93% had PVI alone) had similar arrhythmia‐free survival to patients with PAF (61% vs 67%, respectively; P = 0.42). Recurrence in patients with LVA compared to those without was more likely to be an organized atrial arrhythmia rather than AF (16/30 recurrences vs 2/26, P < 0.001). Conclusions The presence of LVA predicts AFA success as well as the type of arrhythmia recurrence. The absence of LVA identifies Ps AF patients that respond well to a PVI ‐based ablation strategy.

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Long-term results of pulmonary vein antrum isolation in patients with atrial fibrillation: an analysis in regards to substrates and pulmonary vein reconnections

Abstract: The LVZ area was an independent predictor of recurrence after PVAI without any LA substrate modification. Adenosine triphosphate-induced PV reconnection was also an independent predictor, especially in those without LVZs.

Cited by 50 publications

References 30 publications

Efficacy of Left Atrial Voltage‐Based Catheter Ablation of Persistent Atrial Fibrillation

Efficacy of Left Atrial Voltage‐Based Catheter Ablation of Persistent Atrial Fibrillation

Predicting Left Atrial Low-Voltage Areas During Sinus Rhythm on the Basis of Low Voltage During Atrial Fibrillation

The impact of the presence of left atrial low voltage areas on outcomes from pulmonary vein isolation

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