The relationship between the 3D electroanatomical mapping parameters of the left atrial posterior wall and the recurrence of paroxysmal atrial fibrillation

Yuqiao Chen ¹ Jun Zhuang ^1* Xiaolong Li ^1* Chunqin Zhang ^1* Xinfu Cao ^1* Zhiwei Xu ^1* Xiu Feng ^2*

• ¹ Changzhou Traditional Chinese Medicine Hospital, Changzhou, China
• ² First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China

Background Pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation in paroxysmal atrial fibrillation (PAF) .However, AF recurrence after PVI still needs further investigation.The left atrial posterior wall (LAPW) is embryologically related to pulmonary veins (PVs) and plays an important role in the initiation and maintenance of AF.This study aimed to explore the relationship between the 3D electroanatomical mapping parameters of the LAPW and the recurrence in PAF.Methods A retrospective analysis was conducted on patients with PAF who underwent PVI.Both clinical and procedural characteristics were collected.The 3D electroanatomical mapping anatomical and electrical parameters were measured and calculated in the CARTO system. Inter-group comparisons and multivariate logistic regression analysis were performed to demonstrate the relationship between parameters of LAPW and AF recurrence.A combined prediction model for AF recurrence was constructed in this study.Results A total of 120 patients were included in the final analysis. Among procedural characteristics, compared with group 1 (no recurrence) , there was a significantly larger posterior wall surface area (PWSA) (p = 0.013) and the percentage of very low-voltage area (PVLVA) (p < 0.001) in group 2 (recurrence) . Further analysis revealed that there was a significant difference between the two groups in the distribution of very low-voltage area (VLVA) (p = 0.026) . Subsequently, in the multivariate logistic regression analysis, both PWSA and PVLVA were independent risk factors for AF recurrence (OR: 1.457, 95% CI: 1.037-2.049, p = 0.030; OR: 1.059, 95% CI: 1.013-1.107, p = 0.012, respectively) . Finally, a prediction model that the PWSA combined with the PVLVA for AF recurrence was constructed to draw the receiver operating characteristic (ROC) curve. The area under curve (AUC) of this model was 0.900 (0.827, 0.973) (p < 0.001) . The result, evaluated by Hosmer -Lemeshow goodness of fit test, showed that  2 = 4.643 (p = 0.796) .This study demonstrated that both PWSA and PVLVA were independent risk factors for AF recurrence. Moreover, we proposed a model that PWSA combined with PVLVA to predict the recurrence of AF, which may provide an approach for screening PAF patients who may require attention for the LAPW.