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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1427841

The Impact of Atrial Voltage and Conduction Velocity Phenotypes on Atrial Fibrillation Recurrence

Provisionally accepted
Pedro Silva Cunha Pedro Silva Cunha 1*Sérgio Matoso Laranjo Sérgio Matoso Laranjo 1Sofia Monteiro Sofia Monteiro 1Guilherme Portugal Guilherme Portugal 1Cátia Guerra Cátia Guerra 1António Condeixa Rocha António Condeixa Rocha 2Mariana Pereira Mariana Pereira 2Rui Cruz Ferreira Rui Cruz Ferreira 1Jordi Heijman Jordi Heijman 3Mário Martins Oliveira Mário Martins Oliveira 1
  • 1 Hospital de Santa Marta, Lisbon, Portugal
  • 2 Biosense Webster, Shfayim, Israel
  • 3 Medical University of Graz, Graz, Styria, Austria

The final, formatted version of the article will be published soon.

    Introduction: Low atrial voltage and slow conduction velocity (CV) have been associated with atrial fibrillation (AF); however, their interaction and relative importance as early disease markers remain incompletely understood. We aimed to elucidate the relationship between atrial voltage and CV using high-density electroanatomic (HDE) maps of patients with AF. Methods: HDE maps obtained during sinus rhythm in 52 patients with AF and five healthy controls were analysed. Atrial voltage and CV maps were generated, and their correlations were assessed. Subgroup analyses were performed based on clinically relevant factors such as AF type, CV, and voltage levels. Finally, cluster analysis was conducted to identify distinct phenotypes within the population, reflecting different patterns of conduction and voltage. Results: A moderate positive correlation was found between the mean atrial voltage and CV (r=0.570). Subgroup analysis revealed differences in voltage (p=0.0044) but not in global CV (p=0.42), with no significant differences between AF types. Three distinct phenotypes emerged: normal voltage/normal CV, normal voltage/low CV, and low voltage/low CV, with distinct recurrence rates, suggesting different disease progression paths. Slower atrial CV was identified as a significant predictor of arrhythmia recurrence at 12 and 24 months after AF ablation, surpassing the predictive potential of atrial voltage. Conclusion: Atrial voltage and CV analyses revealed distinct phenotypes. Lower atrial CV emerged as a significant predictor of AF recurrence, exceeding the predictive significance of atrial voltage. These findings emphasise the importance of considering CV and voltage in managing AF and offer potential insights for personalised strategies.

    Keywords: Atrial Fibrillation, atrial conduction velocity, voltage, Atrial myopathy, ablation < electrophysiology

    Received: 04 May 2024; Accepted: 29 Nov 2024.

    Copyright: © 2024 Silva Cunha, Laranjo, Monteiro, Portugal, Guerra, Rocha, Pereira, Ferreira, Heijman and Oliveira. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Pedro Silva Cunha, Hospital de Santa Marta, Lisbon, Portugal

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