Sinus Rhythm Deceleration in Low Voltage Zones is Associated with Organized Atrial Tachycardia

Abstract 2304933, presented at Western Atrial Fibrillation Symposium 2026

Organized atrial tachycardias (OATs) occurring after pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF) can represent a source of morbidity and require repeat ablation procedures for treatment. The purpose of this study was to identify risk factors for OAT after PVI, with a focus on isochronal late activation and voltage during mapping in sinus rhythm.Patients who underwent PVI for treatment of AF between May 2021 and October 2025 with interpretable echocardiograms and electroanatomic maps in sinus rhythm or coronary sinus pacing were included. Sinus rhythm deceleration zones (DZs) were identified by isochronal late activation mapping. Voltage < 0.20 mV was considered to be a low voltage zone (LVZ). Logistic regression was used to calculate odds ratios and 95% confidence intervals.We identified 50 patients who were 78% male and had a mean age of 65.88 (+/- 9.77) years. 30% of patients had inducible OATs during programmed stimulation after PVI. Patients with OATs were more likely to be older, have higher CHA2DS2VASc scores, and have LVZs. 98% of all patients had DZs, however those with OATs had more DZs per patient and more DZs in LVZs. If a DZ occurred in an LVZ, the odds of it being implicated in an OAT were 6.31 (CI 2.44-16.93) -fold greater than if it occurred with normal voltage independent of conduction velocity.Sinus rhythm DZs occurring in LVZs are associated with OAT circuits and may be suitable targets to prevent OATs after PVI.