Low-voltage areas have been used as atrial structural substrates in estimating fibrotic degeneration in patients with atrial fibrillation (AF). The high-resolution maps obtained by recently developed mapping catheters allow the visualization of several functional abnormalities. We investigated the association between left atrial (LA) functional abnormal findings on a high-resolution substrate map and AF recurrence in patients who underwent pulmonary vein isolation without any additional LA substrate ablation. This observational study included 100 consecutive patients who underwent second ablation for AF (paroxysmal, 48%; persistent, 52%). Patients with extra-pulmonary-vein LA substrate ablation during the initial and second ablation were excluded. LA mapping was performed using a 64-pole mini-basket catheter on the RHYTHMIA mapping system (Boston Scientific, Marlborough [Cambridge] Massachusetts). Patients were followed for 2 years. AF recurrence developed in 39 (39%) patients. On the high-resolution substrate map, AF recurrence was associated with the presence of the following findings: low-voltage areas (<1.0 mV, >5 cm; hazard ratio [HR] = 2.53; 95% confidence interval [CI] = 1.30 to 4.93; p <0.006), fractionated-electrogram areas (≥5 peaks, >5 cm; HR = 2.15, 95% CI = 1.10 to 4.19; p = 0.025), LA conduction time of >130 ms (HR = 3.11, 95% CI = 1.65 to 5.88, p <0.0001), deceleration zone (≥5 isochrones/cm; HR = 1.97, 95% CI = 1.04 to 3.37, p = 0.039), and multiple septal break-out points (HR = 3.27, 95% CI = 1.50 to 7.16, p = 0.003). Accumulation of these risk factors increased AF recurrence in a stepwise manner, with an HR = 1.90, 95% CI = 1.44 to 2.52, p <0.00001 for each additional risk factor. In conclusion, a high-resolution map revealed new LA functional substrates associated with AF recurrence. Implementation of functional substrates may improve the prediction of AF recurrence after ablation, and possibly aid the development of tailored AF ablation strategies.

中文翻译：

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用于预测肺静脉隔离后心房颤动复发的心房功能基质

低电压区域已被用作心房结构基质来估计心房颤动 (AF) 患者的纤维化变性。通过最近开发的标测导管获得的高分辨率图可以使多种功能异常可视化。我们研究了在未进行任何额外 LA 基质消融的情况下接受肺静脉隔离的患者中高分辨率基质图上左心房 (LA) 功能异常结果与 AF 复发之间的关联。这项观察性研究包括 100 名连续接受 AF 二次消融的患者（阵发性，48%；持续性，52%）。首次和第二次消融期间进行肺外静脉 LA 基质消融的患者被排除。 LA 标测是使用 RHYTHMIA 标测系统（Boston Scientific，马萨诸塞州马尔堡 [剑桥]）上的 64 极迷你篮式导管进行的。对患者进行了两年的随访。 39 名 (39%) 患者出现房颤复发。在高分辨率基质图上，AF 复发与以下发现相关：低电压区域（<1.0 mV，>5 cm；风险比 [HR] = 2.53；95% 置信区间 [CI] = 1.30至 4.93；p <0.006），分割电描记图面积（≥5 个峰值，>5 cm；HR = 2.15，95% CI = 1.10 至 4.19；p = 0.025），LA 传导时间 >130 ms（HR = 3.11， 95% CI = 1.65 至 5.88，p <0.0001）、减速区（≥5 等时线/cm；HR = 1.97，95% CI = 1.04 至 3.37，p = 0.039）和多个间隔突破点（HR = 3.27） ，95% CI = 1.50 至 7.16，p = 0.003）。这些危险因素的积累逐步增加 AF 复发，HR = 1.90，95% CI = 1.44 至 2.52，每个附加危险因素的 p <0.00001。总之，高分辨率图谱揭示了与 AF 复发相关的新 LA 功能基质。功能性基质的实施可以改善消融后房颤复发的预测，并可能有助于制定定制的房颤消融策略。