Recurrence risk of atrial fibrillation in the 1-year post-ablation with radiofrequency in patients with high p wave dispersion and low voltage areas
M Velescu, I A Minciuna, A O Mitre, R Tomoaia, G Cismaru, M Puiu, R O Rosu, G Simu, D PopAbstract
Introduction
Low-voltage areas (LVA), found in the atriums, and P wave dispersion (PWD), an EKG parameter, are two frequently used markers of fibrosis or slow electrical activity zones, and have proven to be highly reliable as risk predictors for newly diagnosed or recurrence of atrial fibrillation (AF) post-cardioversion or ablation.
Purpose
By analysing various cofactors in four subcategorized groups, created based on LVA and PWD values, the present study aims to identify the covariables associated with the highest risk of AF recurrence post-radiofrequency ablation (RFA).
Methods
A total of 196 patients, who had at least one RFA for AF between 2021 and 2024, were divided into four groups using LVA and PWD cut-off values (0,5 cm² for LVA and 32 ms for PWD, selected based on the median value in the studied group). Some of the main cofactors evaluated were heart failure (HF), arterial hypertension (AHT), ischemic coronary artery disease (CAD), type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary diseases (COPD) and myocardial infarction (MI). The statistical analysis was mainly focused on risk prediction and comprised binary regressions and contingency tables.
Results
After the regrouping of values based on the PWD and LVA parameters, the largest subgroup had 95 (48,47%) participants and was represented by those with a value of 0,5 cm² for LVA and under 32 ms for PWD. The initial evaluation of the role of PWD and LVA in predicting the risk of AF recurrence indicated a statistically significant association (Pearson Chi-Square p = 0,002), with a medium effect on the recurrence. The fourth subgroup (LVA present and PWD high) had the highest association with recurrence in the 1-year follow-up, while the other two groups didn’t represent a significant risk factor for the selected outcome. When evaluating the effect of other covariates, such as AHT, COPD, left ventricular ejection fraction, age, sex, and P wave maximum duration, on recurrence, the model with the highest overall accuracy had a 71% (P<0,05) detection of the correct outcome, but with no specific covariate as independent risk factor.
Conclusions
Fibrosis or electrical changes, as seen through the low voltage areas, are directly linked to high risk of new onset/recurrence of atrial fibrillation. Other comorbidities such as arterial hypertension, chronic obstructive pulmonary disease, and heart failure, can elevate the risk, due to cardiovascular remodeling, chronic inflammation or autonomic dysfunction, but didn’t represent an independent risk factor for recurrence. This study focuses on identifying the major risk predictors for AF recurrence, based on various possible associations, in groups based on LVA and PWD values. For a better understanding of each covariates impact on AF recurrence, further prospective studies should be conducted.