Analysis of Similarities and Differences between Biatrial Remodeling Through Electro-Anatomic Mapping in Patients with Atrial Fibrillation.

Background: This study aims to explore the association between LA and RA remodeling and their influences on ablation efficacy in AF patients.

Methods: The study involved AF patients undergoing their first catheter ablation using CARTO 3 system. After isolating pulmonary veins, three-dimensional electro-anatomical mapping (3D-EAM) of LA and RA was conducted during sinus rhythm. Low voltage area (LVA) was defined as regions with bipolar voltage < 0.5 mv. If LVA constituted ≥ 10% of the total area of the ipsilateral atrium, it was considered an extensive LVA (ELVA).

Results: A total of 271 patients (male 58.3%, median age 63 years) were enrolled. Biatrial 3D-EAM found that the RA had a larger volume and volume index, longer total activation time, and higher maximum voltage than the LA (P < 0.001). The presence of LVAs, especially ELVAs, was more common in LA (LVAs: 47 patients (17.3%) vs. 29 patients (10.7%), P = 0.011; ELVAs: 26 patients (9.6%) vs. 7 patients (2.6%), P < 0.001). The multivariate logistic analysis revealed that older age, female gender, persistent AF, and LA enlargement were independent predictors of LA LVAs, while female gender and AF duration were associated with RA LVAs. Strong associations were found between variables reflecting the LA and the RA remodeling. Multivariate Cox regression indicated that ELVA in the LA was the only independent predictor of post-ablation recurrence.

Conclusions: AF patients had different characteristics and intrinsic correlations between LA and RA remodeling. The LVAs, especially the ELVAs, were more prevalent in the LA than in the RA. There were distinctions in related factors and impacts on ablation efficacy between the LA LVAs and the RA LVAs.