Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation
An independent predictor of procedural failure
Atul Verma, MD,
Oussama M. Wazni, MD,
Nassir F. Marrouche, MD,
David O. Martin, MD,
Fethi Kilicaslan, MD,
Stephen Minor, MD,
Robert A. Schweikert, MD,
Walid Saliba, MD,
Jennifer Cummings, MD,
J. David Burkhardt, MD,
Mandeep Bhargava, MD,
William A. Belden, MD,
Ahmad Abdul-Karim, MD and
Andrea Natale, MD*
Section of Cardiovascular Electrophysiology, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
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Figure 1 Kaplan-Meier curves depicting late atrial fibrillation (AF) recurrence in patients with and without left atrial scarring (LAS) over time. Patients with LAS have a significantly increased incidence of late AF recurrence compared with patients without LAS (p < 0.01 by log-rank).
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Figure 2 Representative three-dimensional electroanatomic voltage map (CARTO) depicting left atrial scarring (LAS) in a patient included in this study. Gray regions indicate areas of electrical silence (scar). Red regions indicate areas of abnormal atrial endocardium as defined by a voltage of <0.5 mV. In this case, scarred and abnormal regions constitute almost two-thirds of the atrial surface. The colored tube structures represent the four PVs and their associated branches.
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Figure 3 Multivariate predictors of late atrial fibrillation (AF) recurrence as assessed by Cox regression analysis. Hazard ratios are indicated by the square points, and the 95% confidence interval (CI) is indicated by the solid horizontal lines. P values for each variable are indicated at the right. Only left atrial (LA) scarring was found to be an independent predictor, with a hazard ratio of 3.4 (95% CI 1.3 to 9.4, p = 0.01). EF = ejection fraction; HD = heart disease.
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