# Left atrial remodeling and voltage-guided ablation outcome in persistent atrial fibrillation patients over 75 years of age

## TL;DR

Elderly patients with persistent atrial fibrillation show more left atrial remodeling, but voltage-guided ablation is still effective with low complications.

## Contribution

This study provides insights into left atrial remodeling and ablation outcomes specifically in patients over 75 years with persistent atrial fibrillation.

## Key findings

- Elderly patients had lower left atrial voltage and more low-voltage zones compared to younger patients.
- Voltage-guided ablation outcomes were similar between elderly and younger patients after 36 months of follow-up.
- Female sex, age ≥75, and lower kidney function predicted the presence of low-voltage zones.

## Abstract

The prevalence of atrial fibrillation (AF) increases with age. The improvement in ablation techniques has widened the indications, particularly in elderly patients. Data on LA remodeling and low-voltage zone (LVZ) extent in this subgroup are scarce.

We assessed the left atrial (LA) bipolar voltage, LVZ extent, and efficacy of voltage-guided ablation in a cohort of patients with persistent AF according to age.

Three hundred fifty-three patients with persistent AF undergoing a first voltage-guided ablation procedure were enrolled and divided into 2 groups: those <75 years of age (n=286) and those ≥75 years of age (n=67). LA voltage maps were obtained in sinus rhythm. LVZ was defined as <0.5 mV. A propensity score–matching analysis was used to assess the impact of age on LA remodeling.

The LA bipolar voltage was lower (P<.01) in elderly patients. LVZs were found in 67% of elderly patients and 30% of younger patients (P<.01), especially in mild (P<.01) and moderate (P<.01) LVZs. After propensity score matching, these differences were no longer noticeable. Pulmonary vein isolation alone was performed in 33% of elderly patients and 70% of patients <75 years of age (P<.01). Female sex (P<.001), age ≥ 75 years (P=.042), estimated glomerular filtration rate (P=.009), and LA volume index (P<.001) were predictive of LVZ presence. After 36 months of follow-up, the AF-free survival rate after a single procedure was similar between the 2 groups.

Patients >75 years of age with persistent AF display increased LA substrate remodeling than do younger patients. LA scar did not seem to negatively affect the results of substrate-guided ablation, and the complication rate was low.