Voltage-guided ablation in persistent atrial fibrillation-favorable 1-year outcome and predictors.

Introduction: Pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF) has a low success rate. A newer ablation concept targets left atrial (LA) low voltage zones (LVZ) which correlate with fibrosis and predict recurrence after PVI. We aimed to determine the success of combined PVI- and LVZ-guided ablation and to identify the predictors for LVZ and for ablation success.

Methods And Results: A total of 119 consecutive patients who underwent their first ablation procedure due to persistent AF were included. After acquisition of a high-resolution LA voltage map, PVI- and LVZ-guided ablation were performed. Mean age was 69 ± 8 years, 53% were men, and 8% had longstanding persistent AF. We found LVZ in 55% of patients. Twelve-month freedom from recurrences off drugs was 69%. The only independent predictor for recurrence was the existence of LVZ (OR 4.2, 95% CI 1.54-11.41, p = 0.005). Existence of LVZ was predicted positively by age ≥ 67 years (OR 4.4, 95% CI 1.4-13.7, p = 0.011), LA volume index ≥ 68 ml/m (OR 3.9, 95% CI 1.4-10.5, p = 0.008), and GFR ≤ 85 ml/min/1.73 m (OR 12.5, 95% CI 2.0-76.6, p = 0.006). BMI ≥ 26 kg/m (OR 0.06, 95% CI 0.01-0.30, p = 0.001) was a negative predictor of LVZ.

Conclusion: LVZ-guided ablation in combination with PVI results in comparably high success rates. However, the existence of LVZ remains the strongest predictor of ablation success.