open access

Vol 79, No 5 (2021)
Original article
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Atrial fibrillation risk scores to evaluate left atrial substrate based on voltage analysis in long-standing persistent type of arrhythmia

Radosław Marek Kiedrowicz, Maciej Wielusiński, Andrzej Wojtarowicz, Jarosław Kaźmierczak
DOI: 10.33963/KP.15902
·
Pubmed: 34125925
·
Kardiol Pol 2021;79(5):525-530.

open access

Vol 79, No 5 (2021)
Original article

Abstract

Background: Pre-ablation identification of left atrial (LA) low voltage areas (LVA) among long-standing persistent atrial fibrillation (LSPAF) population remains challenging.
Aims: The aim of the study was to analyze the potential of selected scores originally developed to assess arrhythmia recurrences, thromboembolic complications, or progression from paroxysmal to persistent AF to predict the presence of LA-LVA in LSPAF patients.
Methods: One hundred and fifty-two patients underwent pulmonary vein isolation followed by high-density-high-resolution LA voltage mapping. AF risk scores, such as APPLE, ATLAS, CAAP-AF, DR-FLASH, CHA2DS2-VASc, and HATCH were retrospectively calculated. A receiver operating characteristic curve analysis was performed to evaluate the ability of the scores to predict LVA.
Results: Low voltage areas were detected in 52% of the patients. 28% of the patients with LVA presented severe global LVA burden, whereas 56% of the patients showed a disseminated pattern of remodeling. CAAP-AF ≥7, DR-FLASH ≥4, and CHA2DS2-VASc ≥3 predicted the presence of LVA, whereas ATLAS ≤7 indicated the absence of LVA. ATLAS ≤8, CAAP-AF ≤9, DR-FLASH ≤4, and CHA2DS2-VASc ≤3 predicted the absence of severe LVA. APPLE ≤3 and CHA2DS2-VASc ≤2 predicted the absence of a LVA disseminated pattern. Among predictive scores, ATLAS (AUC, 0.633, 95% CI, 0.543–0.723, P = 0.004), DR-FLASH (AUC, 0.696; 95% CI, 0.594–0.81; P <0.001), and CHA2DS2-VASc (AUC, 0.644; 95% CI 0.518–0.77; P = 0.025) were the best predictors for the absence of LVA, severe LVA and a disseminated pattern of LVA, respectively.
Conclusions: Atrial fibrillation risk stratification with specific scoring systems can unmask the presence of LA-LVA in the LSPAF population.

Abstract

Background: Pre-ablation identification of left atrial (LA) low voltage areas (LVA) among long-standing persistent atrial fibrillation (LSPAF) population remains challenging.
Aims: The aim of the study was to analyze the potential of selected scores originally developed to assess arrhythmia recurrences, thromboembolic complications, or progression from paroxysmal to persistent AF to predict the presence of LA-LVA in LSPAF patients.
Methods: One hundred and fifty-two patients underwent pulmonary vein isolation followed by high-density-high-resolution LA voltage mapping. AF risk scores, such as APPLE, ATLAS, CAAP-AF, DR-FLASH, CHA2DS2-VASc, and HATCH were retrospectively calculated. A receiver operating characteristic curve analysis was performed to evaluate the ability of the scores to predict LVA.
Results: Low voltage areas were detected in 52% of the patients. 28% of the patients with LVA presented severe global LVA burden, whereas 56% of the patients showed a disseminated pattern of remodeling. CAAP-AF ≥7, DR-FLASH ≥4, and CHA2DS2-VASc ≥3 predicted the presence of LVA, whereas ATLAS ≤7 indicated the absence of LVA. ATLAS ≤8, CAAP-AF ≤9, DR-FLASH ≤4, and CHA2DS2-VASc ≤3 predicted the absence of severe LVA. APPLE ≤3 and CHA2DS2-VASc ≤2 predicted the absence of a LVA disseminated pattern. Among predictive scores, ATLAS (AUC, 0.633, 95% CI, 0.543–0.723, P = 0.004), DR-FLASH (AUC, 0.696; 95% CI, 0.594–0.81; P <0.001), and CHA2DS2-VASc (AUC, 0.644; 95% CI 0.518–0.77; P = 0.025) were the best predictors for the absence of LVA, severe LVA and a disseminated pattern of LVA, respectively.
Conclusions: Atrial fibrillation risk stratification with specific scoring systems can unmask the presence of LA-LVA in the LSPAF population.

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Keywords

atrial fibrillation, atrial fibrillation risk scores, long-standing persistent atrial fibrillation, low voltage areas, voltage mapping

About this article
Title

Atrial fibrillation risk scores to evaluate left atrial substrate based on voltage analysis in long-standing persistent type of arrhythmia

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 79, No 5 (2021)

Article type

Original article

Pages

525-530

DOI

10.33963/KP.15902

Pubmed

34125925

Bibliographic record

Kardiol Pol 2021;79(5):525-530.

Keywords

atrial fibrillation
atrial fibrillation risk scores
long-standing persistent atrial fibrillation
low voltage areas
voltage mapping

Authors

Radosław Marek Kiedrowicz
Maciej Wielusiński
Andrzej Wojtarowicz
Jarosław Kaźmierczak

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