Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) Study
Background Left atrial substrate may have mechanistic relevance for ablation of atrial fibrillation (AF). We sought to analyze the relationship between low‐voltage zones (LVZs), transition zones, and AF recurrence in patients undergoing pulmonary vein isolation. Methods and Results We conducted a pr...
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027795 |
| _version_ | 1828014331703328768 |
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| author | Marco Bergonti Francesco Raffaele Spera Teba Gonzalez Ferrero Michelle Nsahlai Alice Bonomi Maxime Tijskens Wim Boris Johan Saenen Wim Huybrechts Hielko Miljoen Jose Ramón González‐Juanatey Jose Luis Martínez‐Sande Lien Vandaele Anouk Wittock Hein Heidbuchel Miguel Valderrábano Moises Rodríguez‐Mañero Andrea Sarkozy |
| author_facet | Marco Bergonti Francesco Raffaele Spera Teba Gonzalez Ferrero Michelle Nsahlai Alice Bonomi Maxime Tijskens Wim Boris Johan Saenen Wim Huybrechts Hielko Miljoen Jose Ramón González‐Juanatey Jose Luis Martínez‐Sande Lien Vandaele Anouk Wittock Hein Heidbuchel Miguel Valderrábano Moises Rodríguez‐Mañero Andrea Sarkozy |
| author_sort | Marco Bergonti |
| collection | DOAJ |
| description | Background Left atrial substrate may have mechanistic relevance for ablation of atrial fibrillation (AF). We sought to analyze the relationship between low‐voltage zones (LVZs), transition zones, and AF recurrence in patients undergoing pulmonary vein isolation. Methods and Results We conducted a prospective multicenter study on consecutive patients undergoing pulmonary vein isolation‐only approach. LVZs and transition zones (0.5–1 mV) were analyzed offline on high‐density electroanatomical maps collected before pulmonary vein isolation. Overall, 262 patients (61±11 years, 31% female) with paroxysmal (130 pts) or persistent (132 pts) AF were included. After 28 months of follow‐up, 73 (28%) patients experienced recurrence. An extension of more than 5% LVZ in paroxysmal AF and more than 15% in persistent AF was associated with recurrence (hazard ratio [HR], 4.4 [95% CI, 2.0–9.8], P<0.001 and HR, 1.9 [95% CI, 1.1–3.7], P=0.04, respectively). Significant association was found between LVZs and transition zones and between LVZs and left atrial volume index (LAVI) (both P<0.001). Thirty percent of patients had significantly increased LAVI without LVZs. Eight percent of patients had LVZs despite normal LAVI. Older age, female sex, oncological history, and increased AF recurrence characterized the latter subgroup. Conclusions In patients undergoing first pulmonary vein isolation, the impact of LVZs on outcomes occurs with lower burden in paroxysmal than persistent AF, suggesting that not all LVZs have equal prognostic implications. A proportional area of moderately decreased voltages accompanies LVZs, suggesting a continuous substrate instead of the dichotomous division of healthy or diseased tissue. LAVI generally correlates with LVZs, but a small subgroup of patients may present with disproportionate atrial remodeling, despite normal LAVI. |
| first_indexed | 2024-04-10T09:59:17Z |
| format | Article |
| id | doaj.art-d3c153067e104894b058173ba8469361 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T09:59:17Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d3c153067e104894b058173ba84693612023-02-16T10:55:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-01-0112110.1161/JAHA.122.027795Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) StudyMarco Bergonti0Francesco Raffaele Spera1Teba Gonzalez Ferrero2Michelle Nsahlai3Alice Bonomi4Maxime Tijskens5Wim Boris6Johan Saenen7Wim Huybrechts8Hielko Miljoen9Jose Ramón González‐Juanatey10Jose Luis Martínez‐Sande11Lien Vandaele12Anouk Wittock13Hein Heidbuchel14Miguel Valderrábano15Moises Rodríguez‐Mañero16Andrea Sarkozy17Department of Cardiology University Hospital Antwerp Antwerp BelgiumDepartment of Cardiology University Hospital Antwerp Antwerp BelgiumComplexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS Santiago de Compostela SpainDepartment of Cardiology DeBakey Heart and Vascular Center, Houston Methodist Hospital Houston TXDepartment of Clinical Science and Community Health University of Milan at Centro Cardiologico Monzino Milan ItalyDepartment of Cardiology University Hospital Antwerp Antwerp BelgiumDepartment of Cardiology University Hospital Antwerp Antwerp BelgiumDepartment of Cardiology University Hospital Antwerp Antwerp BelgiumDepartment of Cardiology University Hospital Antwerp Antwerp BelgiumDepartment of Cardiology University Hospital Antwerp Antwerp BelgiumComplexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS Santiago de Compostela SpainComplexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS Santiago de Compostela SpainDepartment of Cardiology University Hospital Antwerp Antwerp BelgiumDepartment of Anesthesiology University Hospital Antwerp Antwerp BelgiumDepartment of Cardiology University Hospital Antwerp Antwerp BelgiumDepartment of Cardiology DeBakey Heart and Vascular Center, Houston Methodist Hospital Houston TXComplexo Hospitalario Universitario de Santiago de Compostela (CHUS) SERGAS Santiago de Compostela SpainDepartment of Cardiology University Hospital Antwerp Antwerp BelgiumBackground Left atrial substrate may have mechanistic relevance for ablation of atrial fibrillation (AF). We sought to analyze the relationship between low‐voltage zones (LVZs), transition zones, and AF recurrence in patients undergoing pulmonary vein isolation. Methods and Results We conducted a prospective multicenter study on consecutive patients undergoing pulmonary vein isolation‐only approach. LVZs and transition zones (0.5–1 mV) were analyzed offline on high‐density electroanatomical maps collected before pulmonary vein isolation. Overall, 262 patients (61±11 years, 31% female) with paroxysmal (130 pts) or persistent (132 pts) AF were included. After 28 months of follow‐up, 73 (28%) patients experienced recurrence. An extension of more than 5% LVZ in paroxysmal AF and more than 15% in persistent AF was associated with recurrence (hazard ratio [HR], 4.4 [95% CI, 2.0–9.8], P<0.001 and HR, 1.9 [95% CI, 1.1–3.7], P=0.04, respectively). Significant association was found between LVZs and transition zones and between LVZs and left atrial volume index (LAVI) (both P<0.001). Thirty percent of patients had significantly increased LAVI without LVZs. Eight percent of patients had LVZs despite normal LAVI. Older age, female sex, oncological history, and increased AF recurrence characterized the latter subgroup. Conclusions In patients undergoing first pulmonary vein isolation, the impact of LVZs on outcomes occurs with lower burden in paroxysmal than persistent AF, suggesting that not all LVZs have equal prognostic implications. A proportional area of moderately decreased voltages accompanies LVZs, suggesting a continuous substrate instead of the dichotomous division of healthy or diseased tissue. LAVI generally correlates with LVZs, but a small subgroup of patients may present with disproportionate atrial remodeling, despite normal LAVI.https://www.ahajournals.org/doi/10.1161/JAHA.122.027795atrial fibrillationatrial volumefibrosislow‐voltage zonespulmonary vein isolationscar |
| spellingShingle | Marco Bergonti Francesco Raffaele Spera Teba Gonzalez Ferrero Michelle Nsahlai Alice Bonomi Maxime Tijskens Wim Boris Johan Saenen Wim Huybrechts Hielko Miljoen Jose Ramón González‐Juanatey Jose Luis Martínez‐Sande Lien Vandaele Anouk Wittock Hein Heidbuchel Miguel Valderrábano Moises Rodríguez‐Mañero Andrea Sarkozy Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation atrial volume fibrosis low‐voltage zones pulmonary vein isolation scar |
| title | Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) Study |
| title_full | Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) Study |
| title_fullStr | Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) Study |
| title_full_unstemmed | Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) Study |
| title_short | Characterization of Atrial Substrate to Predict the Success of Pulmonary Vein Isolation: The Prospective, Multicenter MASH‐AF II (Multipolar Atrial Substrate High Density Mapping in Atrial Fibrillation) Study |
| title_sort | characterization of atrial substrate to predict the success of pulmonary vein isolation the prospective multicenter mash af ii multipolar atrial substrate high density mapping in atrial fibrillation study |
| topic | atrial fibrillation atrial volume fibrosis low‐voltage zones pulmonary vein isolation scar |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027795 |
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