Impact of left atrial low‐voltage areas during initial ablation procedures on very late recurrence of atrial fibrillation

Abstract Background Very late recurrence of atrial fibrillation (VLRAF) occurring >1 year after catheter ablation may influence long‐term follow‐up strategies, including oral anticoagulant therapy. However, little is known about the predictors of this condition. Given that the prevalence of left atrial low‐voltage areas (LVAs) is strongly associated with the recurrence of atrial tachyarrhythmias following catheter ablation, we hypothesized that VLRAF might occur more frequently in patients with LVAs at the time of initial ablation. The purpose of this study was to investigate the impact of LVAs on VLRAF. Methods This study included 1001 consecutive patients undergoing initial ablation procedures for AF. LVAs were defined as regions with bipolar peak‐to‐peak voltages of <0.50 mV on the voltage map obtained during sinus rhythm after pulmonary vein isolation. During a 1‐year follow‐up period, 248 patients had a late recurrence of AF (LRAF), defined as recurrence within 3–12 months after ablation. The occurrence of VLRAF was examined in 711 patients without LRAF who were followed for more than 1 year. Results A total of 711 patients who did not develop AF recurrence within 1 year and for whom clinical data were available after 1 year were analyzed. During a median follow‐up of 25 (19, 37) months, VLRAF more than 1 year after the initial ablation was detected in 123 patients. On multivariate analysis, independent predictors of VLRAF were the existence of LVAs, female, left atrial diameter and early recurrence of AF. A Kaplan–Meier analysis showed that the AF‐free survival rate was significantly lower in patients with LVAs than in those without LVAs within 1 year and on more than 1‐year follow‐up ( p < .001). An additional Kaplan–Meier analysis of the incidence of VLRAF in propensity score‐matched patients with and without LVAs showed that VLRAF occurred significantly more frequently in patients with LVAs ( p = .003). Conclusions LVAs during the initial AF ablation procedu r es have an impact on VLRAF occurrence.