A new clinical risk score for predicting the prevalence of low-voltage
areas in patients undergoing atrial fibrillation ablation
Abstract
Introduction: Although the presence of left atrial low-voltage areas
(LVAs) is strongly associated with the recurrence of atrial fibrillation
(AF) after ablation, few methods are available to classify the
prevalence of LVAs. The purpose of this study was to establish a risk
score for predicting the prevalence of LVAs in patients undergoing
ablation for AF. Methods: We enrolled 1004 consecutive patients who
underwent initial ablation for AF (age, 68 ± 10 years old; female, 346
(34%); persistent atrial fibrillation, 513 (51%)). LVAs were deemed
present when the voltage map after pulmonary vein isolation demonstrated
low-voltage areas with a peak-to-peak bipolar voltage of <0.5
mV covering ≥5 cm2 of the left atrium. Results: LVAs were present in 206
(21%) patients. The SPEED score was obtained as the total number of
independent predictors as identified on multivariate analysis, namely
female sex (odds ratio (OR) 3.4 [95% confidence interval (CI)
2.2-5.2], p <0.01), persistent AF (OR 1.8 [95% CI
1.1-3.0], p=0.02), age ≥70 years (OR 2.3 [95% CI 1.5-3.4], p
<0.01), elevated brain natriuretic peptide ≥100 pg/ml or
N-terminal pro-brain natriuretic peptide ≥400 pg/ml (OR 1.7 [95% CI
1.02-2.8], p=0.04), and diabetes mellitus (OR 1.8 [95% CI
1.1-2.8], p=0.02). LVAs were more frequent in patients with a higher
SPEED score, and prevalence increased with each additional SPEED score
point (OR 2.4 [95% CI 2.0-2.8], p <0.01). Conclusion: The
SPEED score accurately predicts the prevalence of LVAs in patients
undergoing ablation for AF.