AUTHOR=Marzak Halim , Ringele Romain , Matsushita Kensuke , Marchandot Benjamin , Fitouchi Simon , Cardi Thomas , Kanso Mohamad , Schatz Alexandre , Hammann Justine , Ohlmann Patrick , Morel Olivier , Jesel Laurence 

TITLE=Impact of gender on left atrial low-voltage zones in patients with persistent atrial fibrillation: results of a voltage-guided ablation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1229345

DOI=10.3389/fcvm.2023.1229345

ISSN=2297-055X

ABSTRACT=Background: Gender-related differences have been reported in atrial fibrotic remodeling and prognosis of atrial fibrillation (AF) patients after ablation. We assessed in persistent AF the regional distribution of left atrial (LA) bipolar voltage and the extent of low-voltage zones (LVZ) according to gender as well as the results of voltage-guided substrate ablation.Consecutive patients who underwent a voltage-guided AF ablation were enrolled.LA endocardial voltage maps were obtained using 3D electroanatomical mapping system in sinus rhythm. LVZ was defined as < 0.5 mV.Results: 115 patients were enrolled (74 men, 41 women). LA bipolar voltage amplitude was twice lower in the whole LA (p<0.01) and in each atrial region in women compared to men whereas LA indexed volume was similar. LVZ were found in 56.1% of women and 16.2% of men (p<0.01). LVZ were also more extensive in women (p=0.01), especially in the anterior LA. Atrial voltage alteration occurred earlier in women than in men. In multivariate analysis, female sex (OR 12.99; 95% CI, 3.23-51.63, p=0.0001) and LA indexed volume (OR 1.09; 95% CI, 1.04-1.16, p=0.001) were predictive of LVZ. Atrial arrhythmia-free survival was similar in men and women 36 months after a single ablation procedure.The study reports a strong relationship between female gender and atrial substrate remodeling. Female gender was significantly associated with a higher incidence, earlier occurrence and a greater extent of LVZ compared to men. Despite female specific characteristics in atrial remodeling, LVZ-guided ablation may improve AF ablation outcome in women.