Fibrillatory wave amplitude on transesophageal ECG as a marker of left atrial low‐voltage areas in patients with persistent atrial fibrillation

Abstract

Background

Low‐voltage areas ( LVAs) are frequently observed in patients with persistent atrial fibrillation (Pe AF) and may represent adverse atrial remodeling. However, noninvasive method of evaluating LAVs is not well established.

Methods

In a cohort of 68 patients with Pe AF, endocardial voltage maps of left atrium ( LA) were created during sinus rhythm after pulmonary vein isolation ( PVI). LVAs were defined as areas with electrogram amplitudes <0.5 mV. LA‐ LVAs were correlated with clinical, echocardiographic, surface, and transesophageal electrocardiography ( TE‐ ECG) variables.

Results

LA voltage mapping revealed any degree of LA‐ LVAs in 50 (73.5%) patients. Patients with LA‐ LVAs were older, had a longer history of AF, and lower fibrillatory wave (F wave) amplitude on TE‐ ECG (0.27 ± 0.06 vs 0.39 ± 0.08 mv, p <  .01) as compared to patients without LA‐ LVAs. The extent of LA‐ LVAs was weakly correlated with age ( R =  0.36, p =  .03) and AF duration ( R =  0.26, p =  .02), but significantly correlated with F‐wave amplitude on TE‐ ECG ( R =  −0.57, p < .01). Only F‐wave amplitude on TE‐ ECG was found as independent predictor for the presence of LA‐ LVAs ( OR = 1.53, 95% CI = 1.09–2.96, p =  .03). A receiver operating characteristic ( ROC) curve identified an F‐wave amplitude of 0.29 mV ( AUC = 0.788; sensitivity = 68.4%; specificity = 73.2%) on TE‐ ECG as the optimal cutoff value for predicting LA‐ LVAs.

Conclusions

As a noninvasive investigation, F‐wave amplitude on TE‐ ECG may be used as an indicator for the presence of LA‐ LVAs.