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 cm(2), n = 207) and LVA (≥5 cm(2), 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.