1316Local left atrial conduction velocity and rate-dependent slowing and its relationship with bipolar voltage and drivers in atrial tachycardia and fibrillation

Abstract Aims Myocardial fibrosis is a hallmark of atrial fibrillation (AF) and its characterization could be used to guide ablation procedures. Late gadolinium enhanced-magnetic resonance imaging (LGE-MRI) detects areas of atrial fibrosis. However, its accuracy remains controversial. We aimed to analyse the accuracy of LGE-MRI to identify left atrial (LA) arrhythmogenic substrate by analysing voltage and conduction velocity at the areas of LGE. Methods and results Late gadolinium enhanced-magnetic resonance imaging was performed before ablation in 16 patients. Atrial wall intensity was normalized to blood pool and classified as healthy, interstitial fibrosis, and dense scar tissue depending of the resulting image intensity ratio. Bipolar voltage and local conduction velocity were measured in LA with high-density electroanatomic maps recorded in sinus rhythm and subsequently projected into the LGE-MRI. A semi-automatic, point-by-point correlation was made between LGE-MRI and electroanatomical mapping. Mean bipolar voltage and local velocity progressively decreased from healthy to interstitial fibrosis to scar. There was a significant negative correlation between LGE with voltage (r = −0.39, P < 0.001) and conduction velocity (r = −0.25, P < 0.001). In patients showing dilated atria (LA diameter ≥45 mm) the conduction velocity predictive capacity of LGE-MRI was weaker (r = −0.40 ± 0.09 vs. –0.20 ± 0.13, P = 0.02). Conclusions Areas with higher LGE show lower voltage and slower conduction in sinus rhythm. The enhancement intensity correlates with bipolar voltage and conduction velocity in a point-by-point analysis. The performance of LGE-MRI in assessing local velocity might be reduced in patients with dilated atria (LA diameter ≥45).

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Left atrial scarring and conduction velocity dynamics: Rate dependent conduction slowing predicts sites of localized reentrant atrial tachycardias

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.10.072 ◽

2019 ◽

Vol 278 ◽

pp. 114-119 ◽

Cited By ~ 4

Author(s):

S. Honarbakhsh ◽

R.J. Schilling ◽

M. Orini ◽

R. Providencia ◽

M. Finlay ◽

...

Keyword(s):

Conduction Velocity ◽

Left Atrial ◽

Rate Dependent

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The efficacy of class III D,L sotalol in treatment of left atrial tachycardia after pulmonary vein isolation

Orvosi Hetilap ◽

10.1556/oh.2009.28678 ◽

2009 ◽

Vol 150 (36) ◽

pp. 1694-1700 ◽

Cited By ~ 1

Author(s):

Attila Mihálcz ◽

Csaba Földesi ◽

Attila Kardos ◽

Károly Ladunga ◽

Tamás Szili-Török

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Atrial Tachycardia ◽

Class Iii

Pitvarfibrilláció miatt végzett pulmonalis vena izolációját követően a betegek egy részénél iatrogén bal pitvari tachycardia jelentkezik. Cél: A sotalolterápia hatásosságának összehasonlítása az 1C tip. propafenonnal szemben, a postablatiós arrhythmiák kezelésében. Módszer és eredmények: A vizsgálatba 75, pitvarfibrillációban szenvedő beteget (átlagéletkor 55,4 ± 7,14 év) választottunk, akiknél a pulmonalis vénák valódi elektromos izolálását végeztük. A beavatkozás során az elektromos izolációt körkörös multipoláris katéterrel ellenőriztük. Az ablatiót követően folytattuk az antiarrhythmiás terápiát még minimum 6 hétig, de célunk annak leépítése volt. Az utánkövetést 1, majd 3 havonta tervezett, ambuláns vizsgálatok alapján végeztük. A 12. hónap végén 67 betegnél tudtuk a protokoll szerint gyűjtött adatokat elemezni. 21 betegnél jelentkezett 3 hónapot követően tartósan bal pitvari tachycardia (31,3%). 11 beteg propafenon-, 4 beteg amiodaron- és 6 beteg sotalolterápiában részesült. Az első két csoportnál sotalolterápiára váltottunk, míg az utolsó csoportnál propafenonterápiát kezdtünk. A 12. hónap végére a sotalol hatásossága 80%, a propafenon hatásossága 20% volt. Következtetések: Adataink alapján PV-izolációt követően a sotalolterápia nem hatásosabb a bal pitvari tachycardiák megelőzésében, mint a propafenon. A 3 hónapon túl fellépő postablatiós bal pitvari tachycardiák kezelésében a sotalol hatásosabb, mint az IC-csoportba tartozó propafenon.

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Characterization of Left Atrial Substrate by Comparison of Bipolar Voltage Maps With Standard Focal 4.5 mm Tip Electrode, 1 mm Ring Electrode, and Microelectrode Catheters Using InTEllaMap Orion and IntellaNav MIFI O

Case Medical Research ◽

10.31525/ct1-nct04095559 ◽

2019 ◽

Author(s):

Keyword(s):

Left Atrial ◽

Ring Electrode ◽

Bipolar Voltage

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Faculty Opinions recommendation of Electrophysiologic and electrocardiographic characteristics and radiofrequency catheter ablation of focal atrial tachycardia originating from the left atrial appendage.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1091547.546030 ◽

2007 ◽

Author(s):

Raul Weiss

Keyword(s):

Catheter Ablation ◽

Left Atrial ◽

Radiofrequency Catheter Ablation ◽

Atrial Tachycardia ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Focal Atrial Tachycardia

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Relationship between left atrial strain and left atrial bipolar voltage in patients undergoing catheter ablation for atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0387 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Takahashi ◽

T Kitai ◽

T Watanabe ◽

T Fujita

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Low Voltage ◽

Pulmonary Veins ◽

Global Longitudinal Strain ◽

Inferior Wall ◽

Bipolar Voltage ◽

Global Mean

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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