Predictors of low-voltage zones in patients with persistent atrial fibrillation eligible for catheter ablation: An observational study

J Cardiovasc Electrophysiol. 2024 Jun;35(6):1140-1149. doi: 10.1111/jce.16264. Epub 2024 Apr 1.


Introduction: The presence of low-voltage zones (LVZs) in the left atrium (LA) is associated with the recurrence of atrial fibrillation (AF) following pulmonary vein isolation (PVI). However, there is variability and conflict in the data regarding predictors of LVZs as reported in previous studies. The objective of this study was to identify predictors for the presence of LVZs in a cohort of patients with persistent AF.

Methods: The study prospectively enrolled 439 patients with persistent AF who were scheduled for ablation. Voltage map of the LA was collected using a multipolar catheter. An LVZ was defined as an area of ≥3 cm2 exhibiting a peak-to-peak bipolar voltage of <0.5 mV.

Results: The mean age of the cohort was 65.3 ± 8.6 years and 26.4% were female. Additionally, 25.7% had significant LVZs, most frequently located in the anterior wall of the LA. Multivariable analysis identified the following independent predictors for LVZ: advanced age (OR [odds ratio] = 1.08, 95% CI [confidence interval] = 1.03-1.13, p = .002); female sex (OR = 4.83, 95% CI = 2.66-8.76, p < .001); coronary artery disease (CAD) (OR = 3.20, 95% CI = 1.32-7.77, p = .01) and enlarged LA diameter (OR = 1.10, 95% CI = 1.04-1.17, p = .001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for the final model was 0.829.

Conclusion: Approximately 25% of the patients with persistent AF had LVZs. Advanced age, female sex, CAD, and a larger LA were independent predictors for LVZs with the model demonstrating a very good AUC for the ROC curve. These findings hold the potential to be used to tailor the ablation procedure for the individual patient.

Keywords: atrial fibrillation; catheter ablation; low‐voltage zones; voltage mapping.

Publication types

  • Observational Study

MeSH terms

  • Action Potentials*
  • Age Factors
  • Aged
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / physiopathology
  • Atrial Fibrillation* / surgery
  • Catheter Ablation* / adverse effects
  • Electrophysiologic Techniques, Cardiac
  • Female
  • Heart Atria / physiopathology
  • Heart Atria / surgery
  • Heart Rate*
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests*
  • Prospective Studies
  • Pulmonary Veins / physiopathology
  • Pulmonary Veins / surgery
  • Recurrence*
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Treatment Outcome