Arrhythmias & electrophysiology
Left atrial myopathy development and progression in atrial fibrillation patients with recurrent left atrial ablation procedures: The LAMP-AF study
Authors' conclusion
LA myopathy advances in one-third of repeat AF ablation patients without chamber enlargement, exhibiting heterogeneous progression favoring septal, anterior, and posterior segments while sparing the lateral wall. Baseline CV and LA volume robustly predict LVA progression, indicating functional electrical remodeling precedes structural fibrosis, highlighting the importance of integrating functional markers when characterizing atrial substrate progression.
Study context
- Population
- Adults undergoing de novo left atrial ablation for AF who had repeat ablation
- Participants
- 90 repeat ablation patients
- Exposure
- Patients with vs without LVA progression; predictors of progression and of AF recurrence
- Outcome
- Total LVA
- Follow-up
- Baseline to repeat procedure
Methodological detailslongitudinal
- Longitudinal
Main finding
As reported in the abstract
- Total LVA increased from
- 9.5 ± 16.8% to 19.0 ± 24.7%
- P
- P < .001
Observational data: associations, not effects.
Further findings
12-month AF recurrence predicted by LVA burden
| Estimate | P value | |
|---|---|---|
| LVA burden (baseline)Baseline | odds ratio 3.65 per 1% | P = 0.049 |
| LVA burden (second procedure)At second procedure | odds ratio 2.54 | P = 0.012 |
| Outcome | Progression | No progression |
|---|---|---|
| Baseline characteristics by progression | ||
| CHA2DS2-VASc | 2.75 | 2.05 |
| LA volume | 152 mL | 122 mL |
| Baseline CV | 0.86 m/s | 1.02 m/s |
- Baseline characteristics by progression: CHA2DS2-VASc P = .021
- Baseline characteristics by progression: LA volume P = .008
- Baseline characteristics by progression: Conduction velocity (CV) P = .013
Patients with >10% LVA progression
- Patients with >10% progression
- 33%
- Septal
- 42%
- Anterior
- 37%
- Posterior
- 34%
Multivariable predictors of progression
- Baseline LA volume
- P = 0.002
- CV
- P = 0.043
- R2
- 0.206
Original publication
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