Prognostic impact of atrial cardiomyopathy: Long-term follow-up of patients with and without low-voltage areas following atrial fibrillation ablation
Masaharu Masuda, Yasuhiro Matsuda, Hiroyuki Uematsu, Ayako Sugino, Hirotaka Ooka, Satoshi Kudo, Subaru Fujii, Mitsutoshi Asai, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Takuya Tsujimura, Yosuke Hata, Naoko Higashino, Sho Nakao, Toshiaki Mano
Abstract
BackgroundAtrial cardiomyopathy is known as an underlying pathophysiological factor in the majority of AF patients. Left atrial low-voltage areas (LVAs) are reported to coincide with fibrosis, and to likely represent atrial cardiomyopathy.ObjectiveThis study aimed to delineate differences in the long-term prognosis of patients stratified by the size of LVAs.MethodsThis observational study included 1,488 consecutive patients undergoing initial ablation for AF. LVAs were defined as regions with a bipolar peak-to-peak voltage of < 0.50 mV. The total study population was divided into 3 groups stratified by LVA size: patients with no LVAs (n=1136), those with small (< 20 cm2, n=250) LVAs, and those with extensive (≥ 20 cm2, n=102) LVAs. Composite endpoints of death, heart failure, and stroke were followed for up to 5 years.ResultsComposite endpoints developed in 105 (7.1%) of 1488 patients, and AF recurrence occurred in 410 (27.6%). Composite endpoints developed more frequently in the order of patients with extensive LVAs (19.1%), small LVAs (10.8%), and no LVAs (5.1%; p for trend<0.0001). Multivariable analysis revealed that LVA presence was independently associated with higher incidence of composite endpoints, irrespective of AF recurrence (modified hazard ratio=1.73, 95% confidence interval=1.13-2.64, p=0.011)ConclusionLVA presence and its extent were both associated with poor long-term composite endpoints of death, heart failure, and stroke, irrespective of AF recurrence or other confounders. Underlying atrial cardiomyopathy appears to define a poor prognosis after AF ablation.