Work

Impact of low-voltage area burden and topological obstacles on atrial fibrillation recurrence after pulmonary vein antrum isolation

Year: 2026

Type: article

Abstract: Background Topological obstacles (TOs), electrically isolated regions such as the mitral annulus and atrial scars, can provide reentry circuits in the left atrium. Their quantity and relationship with low-voltage area (LVA) burden may influence recurrent atrial fibrillation (AF), but this impact remains poorly understood. We aimed to investigate the association between TO count, LVA burden, and post-ablation AF recurrence in patients undergoing de novo AF ablation. Methods Patients were categorized by TO counts, identified using pulmonary vein antrum isolation lines and voltage maps. LVA burden (<0.5 mV) was quantified and grouped into quartiles. One-year AF/atrial tachycardia (AT) recurrence was evaluated across groups. Results Among 237 patients (mean age 62.4 ± 8.8 years; 27.0% female, paroxysmal AF 42.6%, follow-up 1.0 ± 0. years), the majority had an intermediate TO count (TO = 3, 75.9%). Patients with the lowest TO count (TO = 1, 5.5%) were significantly older, had higher CHA 2 DS 2 -VASc scores, worse echocardiographic parameters, and the highest mean LVA burden (36.6% ± 24.8%). AF/AT recurrence occurred in 35.4% of patients. Although recurrence rates were numerically higher in patients with extreme TO counts (TO = 1 or ≥4) and lower in those with intermediate counts (TO = 2 or 3), these differences were not statistically significant ( p = 0.433), and the TO group remained non-significantly associated with recurrence after multivariable adjustment for age, AF clinical type, left atrial diameter, left ventricular ejection fraction, CHA 2 DS 2 -VASc score, and LVA burden. TO counts differed significantly across LVA burden quartiles ( p < 0.001), with the greatest variation observed in the group with the highest LVA burden. Dominant frequency and organization index showed no significant intergroup differences. Conclusion Patients with extreme TO counts (TO = 1 or ≥4) showed a numerically higher, although not statistically significant, trend toward post-ablation recurrence compared with those with intermediate counts. TO quantity varied significantly with LVA burden, suggesting that atrial substrate heterogeneity may influence AF recurrence patterns.

Source: Frontiers in Network Physiology

DOI: 10.3389/fnetp.2026.1945351