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This study evaluates left atrial conduction times and conduction velocities based on high-density voltage and activation maps in sinus rhythm (CARTO<jats:sup>\u00ae<\/jats:sup>3 V7) of 53 patients with persistent atrial fibrillation (LVEF 60% (55\u201360 IQR), LAVI 39\u00a0ml\/m<jats:sup>2<\/jats:sup> (31\u201347 IQR), LApa 24\u2009\u00b1\u20096 cm<jats:sup>2<\/jats:sup>). Measurements were made in low voltage areas (LVA\u2009\u2264\u20090.5\u00a0mV) and normal voltage areas (NVA\u2009\u2265\u20091.5\u00a0mV) at the left atrial anterior and posterior walls. Maps of 28 FACM and 25 no FACM patients were analyzed (19 FACM I\/II, 9 FACM III\/IV, LVA 14\u2009\u00b1\u200911 cm<jats:sup>2<\/jats:sup>). Left atrial conduction time averaged to 110\u2009\u00b1\u200924\u00a0ms but was shown to be prolonged in FACM (119\u00a0ms,\u2009+\u200917%) when compared to no FACM patients (101\u00a0ms, <jats:italic>p<\/jats:italic>\u2009=\u20090.005). This finding was pronounced in high-grade FACM (III\/IV) (133\u00a0ms,\u2009+\u200931.2%, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). In addition, the LVA extension correlated significantly with the left atrial conduction time (<jats:italic>r<\/jats:italic>\u2009=\u20090.56, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Conduction velocities were overall slower in LVA than in NVA (0.6\u2009\u00b1\u20090.3 vs. 1.3\u2009\u00b1\u20090.5\u00a0m\/s, -51%, p\u2009&lt;\u20090.001). Anterior conduction appeared slower than posterior, which was significant in NVA (1 vs. 1.4\u00a0m\/s, -29%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) but not in LVA (0.6 vs. 0.8\u00a0m\/s, <jats:italic>p<\/jats:italic>\u2009=\u20090.096). FACM has a significant influence on left atrial conduction characteristics in patients with persistent atrial fibrillation. Left atrial conduction time prolongs with the grade of FACM and the quantitative expanse of LVA up to 31%. LVAs show a 51% conduction velocity reduction compared to NVA. Moreover, regional conduction velocity differences are present in the left atrium when comparing anterior to posterior walls. Our data may influence individualized ablation strategies.<\/jats:p>","DOI":"10.1007\/s00380-023-02282-5","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T15:01:57Z","timestamp":1688742117000},"page":"1277-1287","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Left atrial conduction times and regional velocities in persistent atrial fibrillation patients with and without fibrotic atrial cardiomyopathy"],"prefix":"10.1007","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9782-8311","authenticated-orcid":false,"given":"Emanuel","family":"Heil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Hong","family":"Gerds-Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Keznickl-Pulst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesna","family":"Furundzija-Cabraja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Hohendanner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leif-Hendrik","family":"Boldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Stawowy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Schoeppenthau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,7,7]]},"reference":[{"issue":"10","key":"2282_CR1","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1056\/NEJM199809033391003","volume":"339","author":"M Ha\u00efssaguerre","year":"1998","unstructured":"Ha\u00efssaguerre M, Ja\u00efs P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le M\u00e9tayer P, Cl\u00e9menty J (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. 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Doreen Sch\u00f6ppenthau: DS received travel grants from St. Jude Medical, Bristol\u2013Myers\u2013Squibb and Biosense Webster, a research grant from Biosense Webster and took part in the Boston scientific EP fellowship program. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This retrospective analysis is approved by the ethics committee votum EA2\/249\/18.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}