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

Masuda, Masaharu; Matsuda, Yasuhiro; Uematsu, Hiroyuki; Sugino, Ayako; Ooka, Hirotaka; Kudo, Satoshi; Fujii, Subaru; Asai, Mitsutoshi; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Tsujimura, Takuya; Hata, Yutaka; Toyoshima, Taku; Higashino, Naoko; Nakao, Sho; Mano, Toshiaki

doi:10.1101/2023.02.20.23286210

Cited by 2 publications

(1 citation statement)

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“…18,19 In addition, systemic conditions such as aging might predispose to atrial myocardial degeneration. 20,21 In the sub-analyses of patients stratified by the presence or absence of AF recurrence, the prognostic impact of LVA and its extension was more obvious among patients with AF recurrence than in those without. As shown in Table 3, both LVA and AF recurrence were associated with composite endpoints, independently of each other.…”

Section: Left Atrial Lvas and Poor Prognosismentioning

confidence: 97%

Prognostic impact of atrial cardiomyopathy: Long-term follow-up of patients with and without low-voltage areas following atrial fibrillation ablation

Masuda

Matsuda

Uematsu

et al. 2023

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Background: Atrial cardiomyopathy is known as an underlying pathophysiological factor in the majority of AF patients. Left atrial low-voltage areas (LVAs) are reported to coincide with fibrosis, and to likely represent atrial cardiomyopathy. This study aimed to delineate differences in the long-term prognosis of patients stratified by the size of LVAs. Methods: This observational study included 1,488 consecutive patients undergoing initial ablation for AF. LVAs were defined as regions with a bipolar peak-to-peak voltage of < 0.50 mV. The total study population was divided into 3 groups stratified by LVA size: patients with no LVAs (n=1136), those with small (< 20 cm2, n=250) LVAs, and those with extensive (≥ 20 cm2, n=102) LVAs. Composite endpoints of death, heart failure, and stroke were followed for up to 5 years. Results: Composite endpoints developed in 105 (7.1%) of 1488 patients, and AF recurrence occurred in 410 (27.6%). Composite endpoints developed more frequently in the order of patients with extensive LVAs (19.1%), small LVAs (10.8%), and no LVAs (5.1%; p for trend<0.0001). Multivariable analysis revealed that LVA presence was independently associated with higher incidence of composite endpoints, irrespective of AF recurrence (modified hazard ratio=1.73, 95% confidence interval=1.13-2.64, p=0.011) Conclusions: LVA presence and its extent were both associated with poor long-term composite endpoints of death, heart failure, and stroke, irrespective of AF recurrence or other confounders. Underlying atrial cardiomyopathy appears to define a poor prognosis after AF ablation.

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Section: Left Atrial Lvas and Poor Prognosismentioning

confidence: 97%