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. 2025 Apr 18;6(7):940-948.
doi: 10.1016/j.hroo.2025.04.002. eCollection 2025 Jul.

Low-voltage areas, atrial cardiomyopathy score, and outcomes in patients with preserved ejection fraction after catheter ablation of atrial fibrillation

Hironobu Sumiyoshi  1   2 , Hiroshi Tasaka  2 , Kenta Yoshida  2 , Atsushi Sakata  2 , Akira Mizukami  3 , Hidemori Hayashi  1 , Tohru Minamino  1 , Kazushige Kadota  2
Affiliations

Low-voltage areas, atrial cardiomyopathy score, and outcomes in patients with preserved ejection fraction after catheter ablation of atrial fibrillation

Hironobu Sumiyoshi et al. Heart Rhythm O2. .

Abstract

Background: Left atrial low-voltage areas (LVAs) and the postprocedural atrial cardiomyopathy (AC) score-which incorporates echocardiographic data and brain natriuretic peptide levels-are linked to outcomes in patients undergoing catheter ablation of atrial fibrillation (AF). However, voltage mapping requires considerable time and cost, and the optimal prognostic predictor for patients with preserved left ventricular ejection fraction (LVEF) after AF ablation remains unclear.

Objective: This study analyzed the relationship between LVAs, the AC score, and outcomes among patients with preserved LVEF after AF ablation.

Methods: We retrospectively analyzed 270 patients with preserved LVEF who underwent AF ablation. Blood tests and transthoracic echocardiography were performed 2 weeks before and 3 months after ablation. We defined LVAs as regions with a bipolar peak-to-peak voltage of <0.50 mV. Patients were divided into 2 groups: no LVA (LVA size <5 cm2, n = 207) and LVA (≥5 cm2, n = 63).

Results: Multivariate analysis revealed that both the postprocedural AC score and the presence of LVA were independently associated with AF recurrence (hazard ratio [HR] = 1.49, P < .001; HR = 1.05, P = .004). However, the postprocedural AC score was independently associated with cardiovascular events (HR = 2.22, P < .001), whereas the presence of LVA was not (HR = 1.13, P = .796).

Conclusion: The presence of LVA and the postprocedural AC score are associated with AF recurrence. However, the AC score is a more cost-effective and stronger predictor of cardiovascular events in patients with preserved LVEF after AF ablation than the presence of LVA.

Keywords: Atrial cardiomyopathy; Atrial fibrillation; Catheter ablation; Low-voltage area; Reverse remodeling.

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Figures

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Graphical abstract
Figure 1
Figure 1
Kaplan-Meier curve illustrating the cumulative rate of cardiovascular events stratified by preprocedural AC score, postprocedural AC score, or LVAs. A: Preprocedural AC score. B: Postprocedural AC score. C: LVA. AC = atrial cardiomyopathy; LVA = low-voltage area.
Figure 2
Figure 2
Kaplan-Meier curves illustrating the cumulative rate of AF recurrence stratified by preprocedural AC score, postprocedural AC score, or LVAs. A: Preprocedural AC score. B: Postprocedural AC score. C: LVA. AC = atrial cardiomyopathy; AF = atrial fibrillation; LVA = low-voltage area.
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References

    1. Hindricks G., Potpara T., Dagres N., et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42:373–498. - PubMed
    1. Yang P., Sung J., Jang E., et al. Catheter ablation improves mortality and other outcomes in real-world patients with atrial fibrillation. J Am Heart Assoc. 2020;9 - PMC - PubMed
    1. Goette A., Corradi D., Dobrev D., et al. Atrial cardiomyopathy revisited-evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS) Europace. 2024;26 - PMC - PubMed
    1. Yamaguchi T. Atrial structural remodeling and atrial fibrillation substrate: a histopathological perspective. J Cardiol. 2025;85:47–55. - PubMed
    1. Yamaguchi T., Otsubo T., Takahashi Y., et al. Atrial structural remodeling in patients with atrial fibrillation is a diffuse fibrotic process: evidence from high-density voltage mapping and atrial biopsy. J Am Heart Assoc. 2022;11 - PMC - PubMed

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