Prevalence and multiple predictors of left atrial low voltage in paroxysmal and non-paroxysmal atrial fibrillation patients undergoing ablation: a systematic review and meta-analysis

作者：Carlo-agostino Oliva, Matteo Morello, Jordana Kron, Kenneth A. Ellenbogen, Michele Golino, Roberto De Ponti · 发表于：EP Europace · 年份：2025 · DOI：10.1093/europace/euaf206 · 被引用次数：5 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiac Arrhythmias and Treatments、Cardiovascular Function and Risk Factors

AIMS: In the left atrium (LA), low-voltage areas (LVAs) detected at electroanatomic mapping in patients with atrial fibrillation (AF) are considered expression of atrial cardiomyopathy (AtCM). This meta-analysis aims at assessing the prevalence and predictors of LVAs in a larger AF population undergoing catheter ablation. METHODS AND RESULTS: Studies comparing patients undergoing LA ablation with vs. those without LVAs were included. Meta-analyses were conducted to estimate the prevalence and odds ratios (ORs) for LVAs. Twenty-two studies with 5278 patients were included. Low-voltage areas were present both in paroxysmal (28%) and non-paroxysmal (41%) patients. The strongest predictors of LVA presence were: age > 65 years (OR 3.41), CHA2DS2-VASc score (OR 3.29), non-paroxysmal AF (OR 3.19), NT-proBNP > 365 pg/mL (OR 2.47), female sex (OR 2.40), E/e' ratio (OR 2.31), eGFR < 60 mL/min/m2 (OR 2.28), and LA volume indexed > 34 mL/m2 (OR 1.98). Comorbidities were also predictors but with lower ORs. In subgroup analysis, female sex (OR 3.90) was a predictor only in non-paroxysmal, while LA diameter (OR 2.51) and body mass index (BMI; OR 1.85) positively correlated only in paroxysmal AF. Meta-regression analysis showed that non-paroxysmal AF and age were independently and significantly associated with a greater reduction in BMI in patients with compared to those without LVAs. CONCLUSION: Low-voltage areas can be present in both paroxysmal and non-paroxysmal AF, and can be predicted ...