4.3 AF recurrence using left atrial regional voltage value
During a mean follow-up period of 16 ± 8 months, 126 (31%) patients experienced AF recurrence. Patients with AF recurrence had LVAs more frequently than those without (53% vs. 27%, p<0.001).
Associations between AF recurrence and mapping parameters representing whole left atrial electrophysiological degeneration were explored. Mean regional voltages were significantly lower in patients with AF recurrence than in those without in all 6 regions (Figure 3). Cut-off values of regional voltage obtained by ROC analysis for the prediction of AF recurrence were 0.9 mV for the anterior and septal regions, 1.0 mV for the roof region, 1.2 mV for the posterior region, 1.4 mV for the bottom region, and 1.8 mV for the lateral region) (Supplementary Figure 2). Regions with a mean voltage < the region-specific cut-off value were defined as a mean regional voltage reduction. AF recurrence rates stratified according to the number of regions with mean voltage reduction are presented in Figure 4. AF recurrence rates became higher as the number of regions with a mean voltage reduction increased. On the other hand, left atrial total conduction velocity was significantly lower in patients with AF recurrence than in those without (0.84 ± 0.15 vs. 0.98 ± 0.17 m/s, p <0.005).
Predictors of AF recurrence are presented in Table 3. On the univariate analysis, patients with AF recurrence more frequently had non-paroxysmal AF and left atrial LVAs, and demonstrated a higher left atrial diameter, lower left ventricular ejection fraction, lower left atrial anterior conduction velocity, and higher number of regions with mean voltage reduction. Multivariate analysis revealed that low left ventricular ejection fraction, low left atrial conduction velocity, and a high number of regions with mean voltage reduction were independently associated with AF recurrence.