Shuai Chang,1 Xiaofeng Zhang,1 Chenliang Ge,2 Yanfen Zhong,1 Decai Zeng,1 Yongzhi Cai,1 Tongtong Huang,1 Ji Wu1 

1Department of Ultrasonic Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China; 2Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China

Correspondence: Ji Wu, Department of Ultrasonic Medicine, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road Qingxiu District, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China, Tel +86 15773435752, Email gxnnwuji@163.com

Purpose: Left atrial low-voltage areas (LA-LVAs) identified by 3D-electroanatomical mapping are crucial for determining treatment strategies and prognosis in patients with atrial fibrillation (AF). However, convenient and accurate prediction of LA-LVAs remains challenging. This study aimed to assess the viability of utilizing automatically obtained echocardiographic parameters to predict the presence of LA-LVAs in patients with non-valvular atrial fibrillation (NVAF).
Patients and Methods: This retrospective study included 190 NVAF patients who underwent initial catheter ablation. Before ablation, echocardiographic data were obtained, left atrial volume and strain were automatically calculated using advanced software (Dynamic-HeartModel and AutoStrain). Electroanatomic mapping (EAM) was also performed. Results were compared between patients with LA-LVAs ≥ 5% (LVAs group) and < 5% (non-LVAs group).
Results: LA-LVAs were observed in 81 patients (42.6%), with a significantly higher incidence in those with persistent AF than paroxysmal AF (55.6% vs 19.3%, P < 0.001). Compared with the non-LVAs group, the LVAs group included significantly older patients, lower left ventricular ejection fraction, higher heart rate, and higher E/e’ ratio (P < 0.05). The LVAs group exhibited higher left atrial volumemax index (LAVimax) and lower left atrial reservoir strain (LASr) (P < 0.001). In multivariate analysis, both LAVimax and LASr emerged as independent indicators of LVAs (OR 0.85; 95% CI 0.80– 0.90, P< 0.001) and (OR 1.15, 95% CI 1.02– 1.29, P =0.021). ROC analysis demonstrated good predictive capacity for LA-LVAs, with an AUC of 0.733 (95% CI 0.650– 0.794, P < 0.001) for LAVimax and 0.839 (95% CI 0.779– 0.898, P < 0.001) for LASr.
Conclusion: Automatic assessment of LAVimax and LASr presents a promising non-invasive modality for predicting the presence of LA-LVAs and evaluating significant atrial remodeling in NVAF patients. This approach holds potential for aiding in risk stratification and treatment decision-making, ultimately improving clinical outcomes in patients.

Keywords: echocardiography, Dynamic-HeartModel, AutoStrain, non-valvular atrial fibrillation, left atrial low-voltage areas