The following is a summary of “Characterization of patients with extensive left atrial myopathy referred for atrial fibrillation ablation: incidence, predictors, and outcomes,” published in the June 2024 issue of Cardiology by González-Ferrero et al.
Researchers conducted a retrospective study identifying clinical and echocardiographic features linked to extensive left atrial myopathy (ELAM), assessing the predictive value of established scoring systems (atrial fibrillation (AF) score, APPLE, and DR-FLASH), and evaluating outcomes regarding AF recurrence, left atrial flutter, and post-procedural heart failure admissions.
They included 950 consecutive patients who underwent their first AF ablation. A 3D electroanatomical mapping system (CARTO3, Biosense Webster) utilizing a multipolar mapping catheter (PentaRay, Biosense Webster) was employed. The ELAM was defined as areas with ≥ 50% low voltage. A subanalysis categorized patients into four groups based on ELAM extent (< 10%, 10–20%, 10–20%, and > 30%). Statistical analyses included logistic regressions, Cox proportional hazards models, and log-rank tests to assess predictors linked with ELAM presence and AF recurrence. The model’s predictive ability was prospectively validated in 150 patients, achieving an AUC of 0.90 (95% CI 0.84–0.96).
The results showed that 78 (8.42%) patients had ELAM. Significant predictors included age, female sex, persistent AF, first-degree AV block, and E/e′. The model incorporating the factors performed better than the existing scores (AUC = 0.87). Over a mean follow-up of 20 months (IQR 9 to 36), patients with ELAM had higher rates of AF recurrence (42.02% vs. 26.01%, P=0.030), left atrial flutter (26.03% vs 8.02%, P<0.001), and post-procedural heart failure admissions (12.01% vs. 0.61%, P<0.001) than without ELAM.
Investigators identified age, female sex, persistent AF, first-degree atrioventricular block, and E/e′ as associated with ELAM in AF and linked ELAM to a higher risk of recurrence and heart failure hospitalization.
Source: link.springer.com/article/10.1007/s00392-024-02467-6
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