Association between left atrial low-voltage areas and outcomes of radiofrequency ablation in atrial fibrillation

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Abstract
Aim . To evaluate the impact of the extent of left atrial (LA) low-voltage areas on the risk of atrial arrhythmia recurrence after radiofrequency ablation (RFA) in patients with atrial fibrillation (AF). Methods . The study included 159 patients (mean age 65.36±9.33 years; 61.6% male) undergoing first-time RFA for AF (68.6% paroxysmal, 31.4% persistent). High-density LA voltage mapping was performed using a multielectrode catheter and CARTO 3 system. Areas with bipolar amplitude Results . Arrhythmia recurrence occurred in 40% of patients with persistent AF and 18.3% with paroxysmal AF. LVA% was significantly higher in patients with recurrence (40.40% vs. 4.80%; p < 0.001). In the Cox model, each 1% increase in LVA% was associated with a 3.6% higher recurrence risk (HR 1.036; p < 0.001). After adjustment for AF type and LA volume, LVA% remained an independent predictor (adjusted HR 1.034; p < 0.001). ROC analysis identified an optimal threshold of 22.4% (AUC=0.746). Patients with LVA% ≥22,4% had more than six-fold higher recurrence risk (adjusted HR 6.478; p < 0.001). LVA% measured during AF showed even stronger discrimination (AUC=0.786 for any arrhythmia; AUC=0.790 for atypical flutter/atrial tachycardia recurrence). Conclusions . The extent of low-voltage substrate in the left atrium is a strong and independent predictor of arrhythmia recurrence after RFA. Thresholds of ≥22,4% (or ≥24,7% for mapping during atrial fibrillation) allow reliable risk stratification and may guide individualized ablation strategies.

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