Abstract 9438: Unipolar Voltages Are Associated with Left Atrial Wall Thickness and Predict Atrial Fibrillation Recurrence After Pulmonary Vein Isolation

Abstract

Introduction: This study was conducted to investigate the relationship between left atrial (LA) wall thickness and the corresponding local unipolar/bipolar voltages, and its impact on the atrial fibrillation (AF) recurrence. Methods: Two-hundred-forty-two AF patients (196 male; 62 ± 9 years) who underwent successful PVI were enrolled and classified into the 2 groups: AF-Free group (n = 172), AF did not recur during the mean follow-up periods of 18 ± 8 months; and AF-Rec group (n = 70), those who had AF recurrence. LA wall thickness along the pulmonary vein isolation (PVI) line was measured using computed tomography and the voltage heights were measured by 3D electroanatomical map. Results: Left-superior PV posterior, right-superior PV (RSPV) posterior and right-inferior PV posterior wall thickness in AF-Rec group was significantly thicker than that in AF-Fee group (P < 0.001, respectively). RSPV posterior wall (RSPV-PW) thickness > 1.5 mm was revealed as cut-off value for AF recurrence with the sensitivity (73%) and specificity (71%) (P < 0.001), and was the independent predictor of AF recurrence (Hazard ratio (HR): 4.511, confidence interval: 2.637-7.717, P = 0.001). Although both of the bipolar and unipolar voltages were associated with RSPV-PW thickness, the latter had a stronger correlation (R 2 = 0.0519, P = 0.043 vs R 2 = 0.5099, P = 0.001, respectively). The unipolar voltages of 3.1 mV was defined as cut-off value for AF recurrence prediction (P = 0.001). Conclusions: The current study demonstrated that RSPV-PW hypertrophy had strong correlation with the local unipolar voltages, and that RSPV-PW thickness > 1.5 mm and the unipolar voltage > 3.1 mV can be predictor for AF recurrence, where we should intensively deliver radiofrequency energy for the durable PVI.