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Background: The assessment of noninvasive markers of left atrial (LA) low‐voltage substrate (LVS) enables the identification of atrial fibrillation (AF) patients at risk for arrhythmia recurrence after pulmonary vein isolation (PVI). Methods: In this prospective multicenter study, 292 consecutive AF patients (72% male, 62 ± 11 years, 65% persistent AF) underwent high‐density LA voltage mapping in sinus rhythm. LA‐LVS (<0.5 mV) was considered as significant at 2 cm2 or above. Preprocedural clinical electrocardiogram and echocardiographic data were assessed to identify predictors of LA‐LVS. The role of the identified LA‐LVS markers in predicting 1‐year arrhythmia freedom after PVI was assessed in 245 patients. Results: Significant LA‐LVS was identified in 123 (42%) patients. The amplified sinus P‐wave duration (APWD) best predicted LA‐LVS, with a 148‐ms value providing the best‐balanced sensitivity (0.81) and specificity (0.88). An APWD over 160 ms was associated with LA‐LVS in 96% of patients, whereas an APWD under 145 ms in 15%. Remaining gray zones improved their accuracy by introduction of systolic pulmonary artery pressure (sPAP) of 35 mmHg or above, age, and sex. According to COX regression, the risk of arrhythmia recurrence 12 months following PVI was twofold and threefold higher in patients with APWD 145–160 and over 160 ms, compared to APWD under 145 ms. Integration of pulmonary hypertension further improved the outcome prediction in the intermediate APWD group: Patients with APWD 145–160 ms and normal sPAP had similar outcome than patients with APWD under 145 ms (hazard ratio [HR] 1.62, p =.14), whereas high sPAP implied worse outcome (HR 2.56, p <.001). Conclusions: The APWD identifies LA‐LVS and risk for arrhythmia recurrence after PVI. Our prediction model becomes optimized by means of integration of the pulmonary artery pressure. [ABSTRACT FROM AUTHOR]

Background Atrial fibrillation (AF) progressively leads to electrical remodeling (ER) and anatomical-mechanical remodeling (AR), whose relationships in humans remain poorly known. Methods ER and AR were compared in patients undergoing percutaneous radiofrequency (RF) ablation for AF. ER was defined by right and left appendage activation rates as a surrogate for atrial refractory periods. AR was approached by left atrial (LA) diameters and area and left atrial appendage (LAA) area and contractile function (mean emptying flow velocity) (LAAFV) before RF ablation. Mean duration between successive LAA contractions was considered as LAA mechanical rate. Results Forty-one patients (31 men, age: 64 ± 9 years) with paroxysmal (27%), persistent (61%), or long-persistent AF (12%) were prospectively included (ejection fraction: 44 ± 16%). Parameters exploring AR were highly correlated to each other: LA area (28 ± 7 cm2), LAA area (5.7 ± 2.25 cm2), LA transverse (49 ± 7 mm), and anteroposterior diameter (59 ± 13 mm) or LAAFV (29 ± 13 cm/s; P < 0.05 for each comparison). Parameters exploring ER were also highly correlated: right atrial appendage (RAA; 181 ± 39 ms) and LAA (176 ± 33 ms) activation rates (P < 0.0001). There was no significant correlation between any ER and AR parameter. Only LAA mechanical rate (174 ± 36 ms) was correlated to LAA or RAA activations rates (P ≤ 0.01). Conclusion ER and AR are not mutually related, atrial activation rate being not correlated to LA or LAA size or function. Thus, the mechanisms leading to AF-induced atrial remodeling may differ for anatomical and electrophysiological aspects. [ABSTRACT FROM AUTHOR]

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The article presents a case study of a 68-year-old female with symptomatic recurrent tachycardia. A transthoracic echocardiogram and a 12-lead electrocardiogram (ECG) showed no heart abnormalities. During an electrophysiological study, incessant irregular narrow QRS tachycardia was noted with intracardiac recording. The patient was treated with radiofrequency ablation without complications.