B-PO03-104 CHARACTERISTICS OF SLOW CONDUCTION ZONE IN PERIMITRAL FLUTTER: A PROMISING ABLATION TARGET

Abstract Background The slow conduction zone (SCZ) in the left atrium (LA) detected using 3-D mapping and high-resolution imaging system has attracted attention as an arrhythmia substrate of atrial fibrillation (AF). However, the occurrence mechanism of SCZ remains unclear. Purpose This aim of this study is to clarify whether SCZ is related to the low voltage zone (LVZ) or the LA anatomical contact areas with other organs such as aorta or thoracic spine in patients with AF. Methods We studied 36 patients (21 males, 68±10 years, 14 paroxysmal AF; PAF, 17 persistent AF; PeAF, 5 long-standing persistent AF; LS-PeAF) who received catheter ablation for AF. High-density LA mapping during sinus rhythm or right atrial pacing after pulmonary vein isolation were constructed by acquiring more than 2000 endocardial points in each patient. Isochronal activation maps were created at 5-ms interval setting, and the SCZ was identified on the activation map by finding a site with isochronal crowding of ≥3 isochrones, which are calculated as ≤27 cm/s (figure). The LVZ was defined as the following; mild (<1.5 mV), moderate (<1.0 mV), and severe LA-LVZ (<0.5 mV). The LA contact areas (CoAs; ascending aorta-anterior LA, descending aorta-posterior LA, and vertebrae-posterior LA) were assessed using computed tomography. Results The SCZ was distributed linearly (figure), and observed in 35 of 36 patients (97.2%). The SCZ was often found in the anterior (89%), roof (64%), and septal wall (47%) of LA, and longest in patients with LS-PeAF (PAF: 56±34 mm, PeAF; 79±41 mm, LS-PeAF; 107±34mm, P=0.0351). The prevalence rate of SCZ (97.2%) was higher than LVZ (figure, mild LA-LVZ; 91.7%, moderate LA-LVZ: 66.7%, severe LA-LVZ; 25%). The 55.8% of SCZ overlapped with mild LA-LVZ, 37.6% of SCZ with moderate LA-LVZ, and 19.1% of SCZ with severe LA-LVZ. The LA CoAs were found in all patients. A total of 72 CoAs (average surface area, 7.0±4.0 cm2) were identified. A CoA was found in each of the three representative regions, ascending aorta-anterior LA (4.1±2.0 cm2, 36 of 36 patients, 100%), descending aorta-posterior LA (2.3±1.2 cm2, 12 of 36 patients, 33%), and vertebrae-posterior LA (3.4±2.1 cm2, 24 of 36 patients, 67%). However, only 22% of SCZ matched with the LA anatomical contact areas. Conclusion The slow conduction zone reflects LA electrical remodeling and may be a precursor finding of the low voltage zone, not LA contact areas in patients with atrial fibrillation. Funding Acknowledgement Type of funding source: None

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Entrance Site of the Slow Conduction Zone of Verapamil-Sensitive Idiopathic Left Ventricular Tachycardia:.

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.1998.tb00898.x ◽

1998 ◽

Vol 9 (2) ◽

pp. 184-190 ◽

Cited By ~ 17

Author(s):

LING-PING LAI ◽

JTUNN-LEE LIN ◽

JUEY-JEN HWANG ◽

SHOEI K.STEPHEN HUANG

Keyword(s):

Ventricular Tachycardia ◽

Left Ventricular ◽

Idiopathic Left Ventricular Tachycardia ◽

Slow Conduction ◽

Conduction Zone

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Abstract 13669: Slow Conduction Zone of Left Atrium is a Precursor to Low Voltage Area in Patients With Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.13669 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Hideyuki Kishima ◽

Takanao Mine ◽

Ryo Kitagaki ◽

Eiji Fukuhara ◽

Masaharu Ishihara

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Low Voltage ◽

Anterior Wall ◽

Right Atrial ◽

Wall Region ◽

Contact Areas ◽

Slow Conduction ◽

Conduction Zone ◽

Right Atrial Appendage

Introduction: The slow conduction zone (SCZ) in the left atrium (LA) has attracted attention as an arrhythmia substrate of atrial fibrillation (AF). However, the occurrence mechanism of SCZ remains unclear. Hypothesis: The SCZ is related to the low voltage area (LVA) or the LA anatomical contact areas (CoAs) with other organs in patients with AF. Methods: We studied 100 patients (49 non-paroxysmal AF, 66 males, 67.9 ± 9.9 years) who received catheter ablation for AF. High-density LA mapping during right atrial appendage pacing at a rate of 100 bpm after pulmonary vein isolation were constructed. Isochronal activation maps were created at 5-ms interval setting, and the SCZ was identified on the activation map by finding a site with isochronal crowding of ≥3 isochrones, which are calculated as ≤27 cm/s (Figure). The LVA was defined as the following; mild (<1.3 mV), moderate (<1.0 mV), and severe LVA (<0.5 mV). The CoAs (ascending aorta-anterior LA, descending aorta-posterior LA, and vertebrae-posterior LA) were assessed using computed tomography. Results: The SCZ was distributed linearly (Figure), and observed in 95 of 100 patients (95%). The SCZ was most frequently observed in the anterior wall region (77%). A longer SCZ was significantly associated with a larger LA size and a prevalence of non-PAF. The 51.2±36.2% of SCZ overlapped with mild LVA, 32.9±32.8% of SCZ with moderate LVA, and 14.6±22.0% of SCZ with severe LVA. In contrast, only 25.6±28.0 % of SCZ matched with the CoAs. Conclusion: The slow conduction zone reflects LA electrical remodeling and may be a precursor finding of the low voltage zone, not LA contact areas in patients with atrial fibrillation.

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