TY - JOUR
T1 - Left atrial wall thickness is associated with the low-voltage area in patients with paroxysmal atrial fibrillation
AU - Nakatani, Yosuke
AU - Sakamoto, Tamotsu
AU - Yamaguchi, Yoshiaki
AU - Tsujino, Yasushi
AU - Kataoka, Naoya
AU - Kinugawa, Koichiro
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Purpose: To identify a potential morphological marker of remodeling and electrophysiological dysfunction, we investigated if low wall thickness is associated with low-voltage areas (LVAs) in the left atrium. Methods: Wall thickness was measured by computed tomography and LVA (% area with bipolar voltage < 0.5 mV) by voltage mapping in 43 paroxysmal AF patients. The left atrium was divided into five segments: septal wall, anterior wall, roof wall, posterior wall, and bottom wall in regional analysis. Results: Left atrial wall thickness and LVA were 3.2 ± 0.6 mm and 14% ± 9%, respectively. Multivariate analysis identified left atrial wall thickness and volume as independent determinants of left atrial LVA (thickness, standardized β − 0.374, 95%CI − 23.289 to − 4.534, P = 0.005; volume, standardized β 0.452, 95%CI 0.049–0.214, P = 0.002). In regional analysis, significant LVA (> 10% of segment surface area) was observed in 123 of 215 segments (57%). Segments in the low tertile of wall thickness (< 1.76 mm) had larger LVAs compared with segments in middle (1.76–2.14 mm) and high tertiles (≥ 2.14 mm) (low tertile, 20.3% ± 14.9%; middle tertile, 12.6% ± 11.2%; high tertile, 12.5% ± 12.1%; low vs. middle tertile, P = 0.001; low vs. high tertile, P = 0.001). Area under the receiver operating curve of wall thickness was 0.706 for prediction of significant LVA. A thickness cut-off of 1.90 mm yielded 62% sensitivity, 73% specificity, 75% positive predictive value, and 59% negative predictive value for significant LVA. Conclusion: A thin left atrial wall is an independent predictor of LVA in patients with paroxysmal AF.
AB - Purpose: To identify a potential morphological marker of remodeling and electrophysiological dysfunction, we investigated if low wall thickness is associated with low-voltage areas (LVAs) in the left atrium. Methods: Wall thickness was measured by computed tomography and LVA (% area with bipolar voltage < 0.5 mV) by voltage mapping in 43 paroxysmal AF patients. The left atrium was divided into five segments: septal wall, anterior wall, roof wall, posterior wall, and bottom wall in regional analysis. Results: Left atrial wall thickness and LVA were 3.2 ± 0.6 mm and 14% ± 9%, respectively. Multivariate analysis identified left atrial wall thickness and volume as independent determinants of left atrial LVA (thickness, standardized β − 0.374, 95%CI − 23.289 to − 4.534, P = 0.005; volume, standardized β 0.452, 95%CI 0.049–0.214, P = 0.002). In regional analysis, significant LVA (> 10% of segment surface area) was observed in 123 of 215 segments (57%). Segments in the low tertile of wall thickness (< 1.76 mm) had larger LVAs compared with segments in middle (1.76–2.14 mm) and high tertiles (≥ 2.14 mm) (low tertile, 20.3% ± 14.9%; middle tertile, 12.6% ± 11.2%; high tertile, 12.5% ± 12.1%; low vs. middle tertile, P = 0.001; low vs. high tertile, P = 0.001). Area under the receiver operating curve of wall thickness was 0.706 for prediction of significant LVA. A thickness cut-off of 1.90 mm yielded 62% sensitivity, 73% specificity, 75% positive predictive value, and 59% negative predictive value for significant LVA. Conclusion: A thin left atrial wall is an independent predictor of LVA in patients with paroxysmal AF.
KW - Atrial fibrillation
KW - Atrial remodeling
KW - Atrial wall thickness
KW - Left atrium
KW - Low-voltage area
KW - Voltage mapping
UR - http://www.scopus.com/inward/record.url?scp=85070676157&partnerID=8YFLogxK
U2 - 10.1007/s10840-019-00611-1
DO - 10.1007/s10840-019-00611-1
M3 - 学術論文
C2 - 31410703
AN - SCOPUS:85070676157
SN - 1383-875X
VL - 58
SP - 315
EP - 321
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 3
ER -