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Original Article
Submitted: 2022-07-13
Accepted: 2022-10-28
Published online: 2022-12-29
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Atrial fibrillatory wave amplitude revisited: A predictor of recurrence after catheter ablation independent of the degree of left atrial structural remodeling

Shiro Ishihara1, Mitsunori Maruyama1, Tsuyoshi Nohara1, Wataru Shimizu2, Kuniya Asai2
DOI: 10.5603/CJ.a2022.0120
·
Pubmed: 36588313
Affiliations
  1. Department of Cardiovascular Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
  2. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan

open access

Ahead of print
Original articles
Submitted: 2022-07-13
Accepted: 2022-10-28
Published online: 2022-12-29

Abstract

Background: The fibrillatory wave amplitude (FWA) during atrial fibrillation (AF) is thought to reflect structural atrial remodeling, but it remains unclear what determines the FWA.

Methods: 114 consecutive patients were prospectively studied who underwent catheter ablation of AF. The mean FWA was computed by automated surface ECG analyses. The extent of the left atrial (LA) voltage-defined atrial fibrosis and conduction properties were estimated by a three-dimensional high-density electroanatomical mapping system. The LA size was evaluated by transthoracic echocardiography. The study patients were divided into 2 groups according to an FWA in lead V1 above the median value of 46 µV (high FWA group, n=57) or below 46 µV (low FWA group, n=57).

Results: There were no differences in the age, gender, CHADS2 score, prevalence of paroxysmal AF, medications, ablation strategy, and LA volume index between the two groups. The LA low voltage areas in the low FWA group were not different from those in the high FWA group. The total LA activation time and local LA conduction velocity did not differ between the two groups. During a median follow-up of 710 days, the recurrence rate after ablation was significantly higher in patients with a low FWA than a high FWA (log-rank P=0.02). In a multivariate analysis, non-paroxysmal AF, the LA volume index, and FWA were independent predictors of recurrence after ablation.

Conclusions: The FWA was not correlated with the markers of atrial structural remodeling. Nevertheless, the FWA could still provide information for predicting the clinical outcome after AF ablation.

Abstract

Background: The fibrillatory wave amplitude (FWA) during atrial fibrillation (AF) is thought to reflect structural atrial remodeling, but it remains unclear what determines the FWA.

Methods: 114 consecutive patients were prospectively studied who underwent catheter ablation of AF. The mean FWA was computed by automated surface ECG analyses. The extent of the left atrial (LA) voltage-defined atrial fibrosis and conduction properties were estimated by a three-dimensional high-density electroanatomical mapping system. The LA size was evaluated by transthoracic echocardiography. The study patients were divided into 2 groups according to an FWA in lead V1 above the median value of 46 µV (high FWA group, n=57) or below 46 µV (low FWA group, n=57).

Results: There were no differences in the age, gender, CHADS2 score, prevalence of paroxysmal AF, medications, ablation strategy, and LA volume index between the two groups. The LA low voltage areas in the low FWA group were not different from those in the high FWA group. The total LA activation time and local LA conduction velocity did not differ between the two groups. During a median follow-up of 710 days, the recurrence rate after ablation was significantly higher in patients with a low FWA than a high FWA (log-rank P=0.02). In a multivariate analysis, non-paroxysmal AF, the LA volume index, and FWA were independent predictors of recurrence after ablation.

Conclusions: The FWA was not correlated with the markers of atrial structural remodeling. Nevertheless, the FWA could still provide information for predicting the clinical outcome after AF ablation.

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Keywords

atrial fibrillation, ECG, ablation, fibrillatory wave, remodeling

Supp./Additional Files (2)
Supplemental Figure 1: Kaplan-Meier survival curves showing the freedom from atrial tachyarrhythmias after a single ablation procedure in different ablation strategies.
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Supplemental Figure 2: LVA in the whole LA, local LA CV, and total LA activation time in patients with and without taking β-blockers, class I antiarrhythmic drugs, and amiodarone.
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About this article
Title

Atrial fibrillatory wave amplitude revisited: A predictor of recurrence after catheter ablation independent of the degree of left atrial structural remodeling

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2022-12-29

Page views

176

Article views/downloads

104

DOI

10.5603/CJ.a2022.0120

Pubmed

36588313

Keywords

atrial fibrillation
ECG
ablation
fibrillatory wave
remodeling

Authors

Shiro Ishihara
Mitsunori Maruyama
Tsuyoshi Nohara
Wataru Shimizu
Kuniya Asai

References (17)
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