Abstract 4140117: A novel risk score predicts the prevalence of left atrial low-voltage areas and rhythm outcome in patients undergoing long-standing persistent atrial fibrillation ablation

Abstract

Background: Catheter ablation is a most common treatment for atrial fibrillation (AF), but rhythm outcome after AF ablation in long-standing persistent atrial fibrillation (LS-PerAF) is still poor. Left atrial low-voltage areas (LVAs) is associated with poor rhythm outcome after catheter ablation. However, the predictors of LVAs presence have not been fully elucidated in patients with LS-PerAF. Purpose: The purpose of this study was to establish a novel predictive score for the prevalence of LVAs in patients with LS-PerAF ablation. Methods: In total, 109 consecutive patients who underwent initial ablation for LS-PerAF were included. LS-PerAF was defined as AF whose duration was more than 1 year. LVA was defined as areas with bipolar peak-to-peak voltage of < 0.50mV. A clinical risk score was obtained as the total number of independent predictors analyzed by multivariate logistic regression analysis. AF recurrence after the catheter ablation was followed for 24 months. Results: Of 109 patients with LS-PerAF, LVAs existed in 26 (24%) patients. A novel predictive score, named DESK score, consisted of diabetes mellitus (odds ratio [OR] 3.7, [95% confidence interval {CI} 2.2–11], p = 0.02), age ≥ 70 years (OR 3.8, [95% CI 1.4-10], p = 0.007), female sex (3.0 [95% CI 1.04-8.4], p = 0.04), AF duration ≥ 3.7 years (44 months) (OR 3.7, [95% CI 1.3-11], p =0.02). LVAs were more frequently found in patients with a higher DESK score (OR, 3.5 [95% CI, 1.9–6.5], p < 0.001) (Figure 1A). On receiver operating characteristic curve analysis, DESK score was a moderate predictor of LVAs presence (area under the curve, 0.750; Figure 1B). The optimal cut-off of DESK score was 3 points, corresponding to a 38.5% sensitivity, 97.6% specificity, and 83.5% predictive accuracy. Freedom from AF recurrence was significantly lower in patients with DESK score ≥ 3 than in those with DESK score < 3 (10.4% vs. 43.5%, p = 0.008). Conclusions: In patients who underwent LS-PerAF ablation, the DESK score correlated with the prevalence of LVAs, and associated with poor rhythm outcome.