Association of low-voltage areas with the regional wall deformation and the left atrial shape in patients with atrial fibrillation: A proof of concept study

Abstract Background Low-voltage zone (LVZ) in the left atrium (LA) seems to represent fibrosis. LA longitudinal strain assessed by speckle tracking method is known to correlate with the extent of fibrosis in patients with mitral valve disease. Purpose We sought to identify the relationship between LA longitudinal strain and LA bipolar voltage in patients with atrial fibrillation (AF). We tested the hypothesis that LA strain can predict LA bipolar voltage. Methods A total of 96 consecutive patients undergoing initial AF ablation were analyzed. All patients underwent transthoracic echocardiography including 2D speckle tracking measurement on the day before ablation during sinus rhythm (SR group, N=54) or during AF (AF group, N=42). LA longitudinal strain was measured at basal, mid, and roof level of septal, lateral, anterior, and inferior wall in apical 4- and 2-chamber view. Global longitudinal strain (GLS) was defined as an average value of the 12 segments. LA voltage map was created using EnSite system, and global mean voltage was defined as a mean of bipolar voltage of the whole LA excluding pulmonary veins and left atrial appendage. LVZ was defined as less than 1.0 mV. Results There was a significantly positive correlation between GLS and global mean voltage (r=0.708, p<0.001). Multivariate regression analysis showed that GLS and age were independent predictors of global mean voltage. There was a significant negative correlation between global mean voltage and LVZ areas. Conclusions There was a strong correlation between LA longitudinal strain and LA mean voltage. GLS can independently predict LA mean voltage, subsequently LVZ areas in patients with AF. Funding Acknowledgement Type of funding source: None

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Targeting Bachmann’s bundle in hybrid ablation for long-standing persistent atrial fibrillation: a proof of concept study

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-00971-7 ◽

2021 ◽

Author(s):

Giuseppe De Martino ◽

Giuseppe Nasso ◽

Alessio Gasperetti ◽

Marco Moscarelli ◽

Carmine Mancusi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Persistent Atrial Fibrillation ◽

Proof Of Concept ◽

Concept Study ◽

Hybrid Ablation ◽

Bachmann’S Bundle

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P613Cardiac magnetic resonance imaging derived left ventricular mechanical function in patients with atrial fibrillation and left atrial low voltage zones

European Heart Journal ◽

10.1093/eurheartj/ehz747.0222 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Ulbrich ◽

R S Schoenbauer ◽

B Kirstein ◽

J Tomala ◽

Y Huo ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Atrial Fibrillation ◽

Magnetic Resonance ◽

Stroke Volume ◽

Left Atrial ◽

Low Voltage ◽

Left Ventricular ◽

Left Ventricular Stroke Volume ◽

Resonance Imaging ◽

Ventricular Filling

Abstract Background The relation of left atrial low voltage zones (LVZ) to left ventricular function in patients undergoing pulmonary vein isolation (PVI) is not known. Objective To explore the relationship of left atrial low voltage zones (LVZ) on left ventricular function in patients with atrial fibrillation. Methods From June to Nov. 2018, 107 (mean age 67y, 70 men, 73 persistent AF) consecutive patients with symptomatic AF underwent a PVI with LVZ mapping. Before PVI the left ventricular ejection fraction (EF) and stroke volume (SV) were measured by cardiac magnetic resonance imaging (CMR). From feature-tracking of CMR-cine images left ventricular global, systolic and diastolic longitudinal strains (GLS), circumferential strains (GCS) and radial strains (GRS) were calculated. Results Of 59 patients CMR scanning in sinus rhythm was performed, LVZ were present in 24 patients. LVEF was significantly lower in patients with left atrial LVZ (62±9% vs. 55±15%) (p=0,03). Left ventricular stroke volume was significantly decreased by the extent of LVZ (94±23 vs. 72±21ml), (p=0,03). The left ventricular diastolic strains during ventricular filling (caused by atrial contraction) of GLS (r=−0,52), GCS (r=−0,65) and GRS (r=−0,65) were highly signifcantly correlated to the occurence and extent of LVZ (each p<0,001 respectively). The only systolic ventricular strain was GLS, which decreased (r=−0,3, p=0,03) by the occurance of atrial low voltage. Conclusion The active, atrial part of diastolic left ventricular filling properties is impaired by the occurrence and extent of left atrial LVZ. In patients with left atrial LVZ the left ventricular stroke volume and ejection fraction is decreased already in sinus rhythm. It seems possible that atrial mechanical dysfunction and presence of atrial low voltage maybe predicted by LV diastolic strain analysis.

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P1731The distribution and predictors of left atrial low voltage zone in patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehx502.p1731 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

T. Omuro ◽

Y. Yoshiga ◽

A. Shimizu ◽

T. Ueyama ◽

M. Ono ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Low Voltage

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P1148Spatial correlation of rotational and continuous electrical activities to late gadolinlium enhancement at left atrial MRI and low voltage areas in persistent atrial fibrillation

EP Europace ◽

10.1093/europace/euy015.634 ◽

2018 ◽

Vol 20 (suppl_1) ◽

pp. i218-i218

Author(s):

J Chen ◽

T Arentz ◽

Z Moreno-Weidmann ◽

B Mueller-Edenborn ◽

H Lehrmann ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Low Voltage ◽

Persistent Atrial Fibrillation ◽

Electrical Activities

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Extent and spatial distribution of left atrial arrhythmogenic sites, late gadolinium enhancement at magnetic resonance imaging, and low-voltage areas in patients with persistent atrial fibrillation: comparison of imaging vs. electrical parameters of fibrosis and arrhythmogenesis

EP Europace ◽

10.1093/europace/euz159 ◽

2019 ◽

Vol 21 (10) ◽

pp. 1484-1493 ◽

Cited By ~ 9

Author(s):

Juan Chen ◽

Thomas Arentz ◽

Hubert Cochet ◽

Björn Müller-Edenborn ◽

Steven Kim ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Atrial Fibrillation ◽

Magnetic Resonance ◽

Left Atrial ◽

Low Voltage ◽

Spatial Relationship ◽

Delayed Enhancement ◽

Resonance Imaging ◽

Spatio Temporal ◽

Temporal Dispersion

Abstract Aims Atrial fibrosis contributes to arrhythmogenesis in atrial fibrillation and can be detected by MRI or electrophysiological mapping. The current study compares the spatial correlation between delayed enhancement (DE) areas to low-voltage areas (LVAs) and to arrhythmogenic areas with spatio-temporal dispersion (ST-Disp) or continuous activity (CA) in atrial fibrillation (AF). Methods and results Sixteen patients with persistent AF (nine long-standing) underwent DE-magnetic resonance imaging (1.25 mm × 1.25 mm × 2.5 mm) prior to pulmonary vein isolation. Left atrial (LA) voltage mapping was acquired in AF and the regional activation patterns of 7680 AF wavelets were analysed. Sites with ST-Disp or CA were characterized (voltage, duration) and their spatial relationship to DE areas and LVAs <0.5 mV was assessed. Delayed enhancement areas and LVAs covered 55% and 24% (P < 0.01) of total LA surface, respectively. Delayed enhancement area was present at 61% of LVAs, whereas low voltage was present at 28% of DE areas. Most DE areas (72%) overlapped with atrial high-voltage areas (>0.5 mV). Spatio-temporal dispersion and CA more frequently co-localized with LVAs than with DE areas (78% vs. 63%, P = 0.02). Regional bipolar voltage of ST-Disp vs. CA was 0.64 ± 0.47 mV vs. 0.58 ± 0.51 mV. All 28 ST-Disp and 56 CA areas contained electrograms with prolonged duration (115 ± 14 ms) displaying low voltage (0.34 ± 0.11 mV). Conclusion A small portion of DE areas and LVAs harbour the arrhythmogenic areas displaying ST-Disp or CA. Most arrhythmogenic activities co-localized with LVAs, while there was less co-localization with DE areas. There is an important mismatch between DE areas and LVAs which needs to be considered when used as target for catheter ablation.

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