Slow left atrial conduction velocity in the anterior wall calculated by electroanatomic mapping predicts atrial fibrillation recurrence after catheter ablation-Systematic review and meta-analysis

Background: This study aimed to investigate and perform diagnostic test meta-analysis on whether slow left atrial conduction velocity (LACV) in the anterior wall calculated by electroanatomic mapping predicts atrial fibrillation (AF) recurrence after catheter ablation. Methods: Extensive literature search was performed on PubMed, SCOPUS, and EuropePMC up to June 5, 2024. The exposure group included AF patients with slow LACV in the anterior wall, while the control group included AF patients without slow LACV in the anterior wall. Slow LACV in the anterior wall was defined as LACV below study-specific cut-off points in m/s, measured by invasive electroanatomic mapping. The primary outcome of this study was AF recurrence, defined as AF/Atrial Flutter/Atrial Tachyarrhythmias lasting over 30 s at least 3 months after the blanking period postablation. Results: This systematic review and meta-analysis included seven studies, involving a sample size of 1428 patients with mean follow-up duration were 13 months. Patients with AF recurrence has slower LACV in the anterior wall (mean difference - 0.16 m/s [-0.18, -0.15], p < .001). Slow LACV in the anterior wall defined as LACV below 0.70-0.88 m/s was associated with increased AF (adjusted OR 3.41 [1.55, 7.50], p = .002). Slow LACV in the anterior wall has an AUROC of 0.80 [0.76-0.83], sensitivity of 70% [52, 84], specificity of 76% [67, 83], positive likelihood ratio of 2.9 [2.3, 3.6], negative likelihood ratio of 0.39 [0.25, 0.63] for predicting AF recurrence postablation. Conclusion: Slow LACV in the anterior wall was associated with AF recurrence after catheter ablation.