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Slow whole left atrial conduction velocity after pulmonary vein isolation predicts atrial fibrillation recurrence
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  • Naoya Kurata,
  • Masaharu Masuda,
  • Takashi Kanda,
  • Mitsutoshi Asai,
  • Osamu Iida,
  • Shin Okamoto,
  • Takayuki Ishihara,
  • Kiyonori Nanto,
  • Takuya Tsujimura,
  • Yasuhiro Matsuda,
  • Yosuke Hata,
  • Toshiaki Mano
Naoya Kurata
Kansai Rosai Hospital
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Masaharu Masuda
Kansai Rosai Hospital
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Takashi Kanda
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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Takuya Tsujimura
Kansai Rosai Hospital
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Yasuhiro Matsuda
Kansai Rosai Hospital
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Yosuke Hata
Kansai Rosai Hospital
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Toshiaki Mano
Kansai Rosai Hospital
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Peer review status:ACCEPTED

11 Apr 2020Submitted to Journal of Cardiovascular Electrophysiology
13 Apr 2020Submission Checks Completed
13 Apr 2020Assigned to Editor
14 Apr 2020Reviewer(s) Assigned
19 Apr 2020Review(s) Completed, Editorial Evaluation Pending
20 Apr 2020Editorial Decision: Revise Minor
26 Apr 20201st Revision Received
27 Apr 2020Submission Checks Completed
27 Apr 2020Assigned to Editor
27 Apr 2020Reviewer(s) Assigned
29 Apr 2020Review(s) Completed, Editorial Evaluation Pending
29 Apr 2020Editorial Decision: Accept

Abstract

Background: Atrial conduction velocity may represent atrial fibrillation (AF) substrate after pulmonary vein isolation (PVI). To elucidate the association between whole left atrial conduction velocity (LACV) and AF recurrence after PVI. Methods and Results: This observational study enrolled 279 patients who underwent PVI alone as an initial AF ablation procedure. After PVI, the left atrium was mapped with a 20-pole multielectrode in conjunction with the CARTO3 system during 100-ppm right atrial pacing. Left atrial conduction distance and conduction time were calculated from the start to the end of the propagation wave front in the left atrium. LACVs on the anterior and posterior routes were calculated as conduction distance divided by conduction time. Anterior and posterior LACVs were slower in patients with AF recurrence than in those without (anterior, 0.79 [0.71, 0.86] vs. 0.96 [0.90, 1.06], p < 0.001; posterior, 0.99 [0.89, 1.14] vs. 1.10 [1.00, 1.29], p < 0.001). AF recurrence was best predicted by anterior LACV with a cut-off value of 0.87 m/s (sensitivity 87%, specificity 81%, and predictive accuracy 84%). Multivariate analysis demonstrated that a slow anterior LACV < 0.87 m/s was an independent predictor of AF recurrence with an adjusted hazard ratio of 11.8 (6.36 – 22.0). Patients with anterior low-voltage areas demonstrated slower anterior LACV than those without low-voltage areas (0.89 [0.71, 1.00] vs. 0.94 [0.87, 1.05], p < 0.001). Conclusion: A slow LACV in the entire left atrium was an excellent predictor of AF recurrence after PVI, suggesting the necessity of additional ablations.