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Computed tomography‐derived left atrial volume index, sex, and age to predict the presence and the extent of left atrial low‐voltage zones in patients with atrial fibrillation: The ZAQ score
Author(s) -
D'Ambrosio Gabriele,
Romano Silvio,
Alothman Obaida,
Frommhold Markus,
Borisov Georgi,
El Garhy Mohammad,
Issa Karam,
Penco Maria,
Raffa Santi,
Geller J. Christoph
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14391
Subject(s) - medicine , atrial fibrillation , catheter ablation , interquartile range , pulmonary vein , cardiology , confidence interval , cohort , atrial tachycardia , ablation , hazard ratio , area under the curve , nuclear medicine , radiology
Background Pulmonary vein isolation is the cornerstone of catheter ablation in patients with atrial fibrillation (AF). However, with advanced left atrial (LA) structural changes, additional targeted catheter ablation of low‐voltage zones (LVZs) has produced favorable results. Therefore, with the advent of single‐shot techniques, it would be helpful to predict the presence of LVZs before an ablation procedure. Objective We hypothesized that computed tomography (CT)‐derived left atrial volume index (LAVI), in combination with other objective parameters, could be used to develop a score able to predict the presence of LVZs. Methods In a large cohort of patients undergoing their first AF ablations, comprehensive echocardiographic evaluations and cardiac CT were performed. During the electrophysiological studies, LA geometry and electroanatomic voltage maps were created. LVZs were defined as areas ≥1 cm 2 with bipolar peak‐to‐peak voltage amplitudes ≤0.5 mV. Results In a derivation cohort of 374 patients, predictors of LVZs were identified by regression analysis and used to build the Zentralklinik Bad Berka and University of L'Aquila (ZAQ) score (age ≥65 years; female sex; and CT‐LAVI ≥57 mL/m 2 ). The ZAQ score of 2 points accurately identified the presence and the extent of LVZs (area under the curve [AUC], 0.809; 95% confidence interval [CI], 0.758‐0.861; P < .001 and 3 [interquartile range, IQR, 1.5‐4.5] vs 7 cm 2 [IQR 4‐9]; P = .001). In a validation cohort of 103 patients, the predictive value of the score was confirmed (AUC, 0.793; 95% CI, 0.709‐0.878; P < .001 and 4 [IQR, 2‐7] vs 11.5 cm 2 [IQR, 8‐16.5]; P = .001). Conclusions The ZAQ score identifies LVZs and may be useful for planning the ablation strategy ahead of time.