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

Background Low‐voltage areas ( LVA s) are frequently observed in patients with persistent atrial fibrillation (Pe AF ) and may represent adverse atrial remodeling. However, noninvasive method of evaluating LAV s 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 ). LVA s were defined as areas with electrogram amplitudes <0.5 mV . LA ‐ LVA s were correlated with clinical, echocardiographic, surface, and transesophageal electrocardiography ( TE ‐ ECG ) variables. Results LA voltage mapping revealed any degree of LA ‐ LVA s in 50 (73.5%) patients. Patients with LA ‐ LVA s 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 ‐ LVA s. The extent of LA ‐ LVA s 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 ‐ LVA s ( 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 ‐ LVA s. Conclusions As a noninvasive investigation, F‐wave amplitude on TE ‐ ECG may be used as an indicator for the presence of LA ‐ LVA s.