Voltage-guided ablation in persistent atrial fibrillation-favorable 1-year outcome and predictors

Introduction Pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF) has a low success rate. A newer ablation concept targets left atrial (LA) low voltage zones (LVZ) which correlate with fibrosis and predict recurrence after PVI. We aimed to determine the success of combined PVI- and LVZ-guided ablation and to identify the predictors for LVZ and for ablation success. Methods and results A total of 119 consecutive patients who underwent their first ablation procedure due to persistent AF were included. After acquisition of a high-resolution LA voltage map, PVI- and LVZ-guided ablation were performed. Mean age was 69 +/- 8 years, 53% were men, and 8% had longstanding persistent AF. We found LVZ in 55% of patients. Twelve-month freedom from recurrences off drugs was 69%. The only independent predictor for recurrence was the existence of LVZ (OR 4.2, 95% CI 1.54-11.41,p= 0.005). Existence of LVZ was predicted positively by age >= 67 years (OR 4.4, 95% CI 1.4-13.7,p= 0.011), LA volume index >= 68 ml/m(2)(OR 3.9, 95% CI 1.4-10.5,p= 0.008), and GFR <= 85 ml/min/1.73 m(2)(OR 12.5, 95% CI 2.0-76.6,p= 0.006). BMI >= 26 kg/m(2)(OR 0.06, 95% CI 0.01-0.30,p= 0.001) was a negative predictor of LVZ. Conclusion LVZ-guided ablation in combination with PVI results in comparably high success rates. However, the existence of LVZ remains the strongest predictor of ablation success.