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A new clinical risk score for predicting the prevalence of low-voltage areas in patients undergoing atrial fibrillation ablation
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  • Yasuhiro Matsuda,
  • Masaharu Masuda,
  • Mitsutoshi Asai,
  • Osamu Iida,
  • Shin Okamoto,
  • Takayuki Ishihara,
  • Kiyonori Nanto,
  • Takashi Kanda,
  • Takuya Tsujimura,
  • Yosuke Hata,
  • Hiroyuki Uematsu,
  • Toshiaki Mano
Yasuhiro Matsuda
Kansai Rosai Hospital
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Masaharu Masuda
Kansai Rosai Hospital
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Mitsutoshi Asai
Kansai Rosai Hospital
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Osamu Iida
Kansai Rosai Hospital
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Shin Okamoto
Kansai Rosai Hospital
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Takayuki Ishihara
Kansai Rosai Hospital
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Kiyonori Nanto
Kansai Rosai Hospital
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Takashi Kanda
Kansai Rosai Hospital
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Takuya Tsujimura
Kansai Rosai Hospital
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Yosuke Hata
Kansai Rosai Hospital
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Hiroyuki Uematsu
Kansai Rosai Hospital
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Toshiaki Mano
Kansai Rosai Hospital
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Abstract

Introduction: Although the presence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial fibrillation (AF) after ablation, few methods are available to classify the prevalence of LVAs. The purpose of this study was to establish a risk score for predicting the prevalence of LVAs in patients undergoing ablation for AF. Methods: We enrolled 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; female, 346 (34%); persistent atrial fibrillation, 513 (51%)). LVAs were deemed present when the voltage map after pulmonary vein isolation demonstrated low-voltage areas with a peak-to-peak bipolar voltage of <0.5 mV covering ≥5 cm2 of the left atrium. Results: LVAs were present in 206 (21%) patients. The SPEED score was obtained as the total number of independent predictors as identified on multivariate analysis, namely female sex (odds ratio (OR) 3.4 [95% confidence interval (CI) 2.2-5.2], p <0.01), persistent AF (OR 1.8 [95% CI 1.1-3.0], p=0.02), age ≥70 years (OR 2.3 [95% CI 1.5-3.4], p <0.01), elevated brain natriuretic peptide ≥100 pg/ml or N-terminal pro-brain natriuretic peptide ≥400 pg/ml (OR 1.7 [95% CI 1.02-2.8], p=0.04), and diabetes mellitus (OR 1.8 [95% CI 1.1-2.8], p=0.02). LVAs were more frequent in patients with a higher SPEED score, and prevalence increased with each additional SPEED score point (OR 2.4 [95% CI 2.0-2.8], p <0.01). Conclusion: The SPEED score accurately predicts the prevalence of LVAs in patients undergoing ablation for AF.

Peer review status:Published

14 Jul 2020Submitted to Journal of Cardiovascular Electrophysiology
14 Jul 2020Submission Checks Completed
14 Jul 2020Assigned to Editor
16 Jul 2020Reviewer(s) Assigned
15 Aug 2020Review(s) Completed, Editorial Evaluation Pending
17 Aug 2020Editorial Decision: Revise Minor
23 Aug 20201st Revision Received
24 Aug 2020Assigned to Editor
24 Aug 2020Submission Checks Completed
24 Aug 2020Reviewer(s) Assigned
27 Aug 2020Review(s) Completed, Editorial Evaluation Pending
04 Sep 2020Editorial Decision: Revise Minor
07 Sep 20202nd Revision Received
08 Sep 2020Submission Checks Completed
08 Sep 2020Assigned to Editor
08 Sep 2020Reviewer(s) Assigned
14 Sep 2020Review(s) Completed, Editorial Evaluation Pending
21 Sep 2020Editorial Decision: Accept
23 Sep 2020Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.14761