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.