Arrhythmias & electrophysiology
Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study
Authors' conclusion
Our study describes bidirectional dynamic properties of the LA substrate with concordant either progressive or regressive changes. Regression occurs with reduced AF burden after the first procedure, while progression is associated with persistent AF recurrence despite durable PV isolation.
Study context
- Population
- Patients with atrial fibrillation (AF) undergoing first pulmonary vein isolation (PVI)-only and redo ablation, with high-density left atrial (LA) maps of both procedures56 high-density LA maps
- Participants
- 28 patients
- Exposure
- Substrate progression vs regression between first PVI and redo ablation
- Progressionn = 17
- Regressionn = 11reference
- Outcome
- Change in LA substrate (bipolar voltages) between first and second procedure
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
Global bipolar voltage change
| Group | Value | Global voltage change |
|---|---|---|
| Progression | 61% | −35%, P < 0.001 |
| Regression | 39% | +43%, P < 0.001 |
Value
Progression61%
Regression39%
Global voltage change
Progression−35%, P < 0.001
Regression+43%, P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | Progression | Regression | P value |
|---|---|---|---|
| LVZ area change | +3.5 cm² | −4.5 cm² | P < 0.001 |
| LA activation time change | +8.0 ms | −9.1 ms | P = 0.005 |
Predictors and clinical correlates of progression
- Pulmonary veins (PVs) more frequently isolated with progression
- P = 0.02
- Persistent AF pattern at recurrence more frequent with progression
- P = 0.005
- Baseline clinical parameters did not predict progression or regression
Original publication
Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study. Europace. Published 3 October 2023. doi:10.
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