scholarly journals Electrograms from the coronary sinus as a predictor for the outcome of a re-do pulmonary vein isolation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Mohsen ◽  
N Grossmann ◽  
J Draheim ◽  
M Horlitz ◽  
F Stoeckigt
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Coronary Sinus ◽  
Left Atrial ◽  
High Sensitivity ◽  
Signal Amplitude ◽  
Atrial Fibrosis ◽  
Left Atrial Fibrosis ◽  
Diagnostic Catheter ◽  
Af Recurrence

Abstract Background Voltage signals in the coronary sinus (CS) have been associated with the presence of left atrial fibrosis. The aim of the present study was to evaluate the value of CS voltage signals as a predictor for atrial fibrillation (AF)-recurrence-free outcome of pulmonary vein isolationprocedures (PVI) in patients after a first unsuccessful cryo-balloon PVI. Method We collected recordings from a diagnostic catheter positioned in the CS from 282 consecutive atrial fibrillation patients undergoing a re-dopulmonary vein isolation using a 3D mapping system. The patients were followed-up (Holter ECG and telephone calls) for at least one year (median of 14 months). Results Of the 282 patients (male 72%, mean age 63±10.8 years, 61% persistent AF) AF recurrences were documented in 152 pts (54%)with a signal amplitude in the proximal CS position of 2.4 mV ± 1.5 mV. Patients free of AF-recurrence showed significantly higher signal amplitude of 2.9 mV ± 2.1 mV (P<0,05). A CS voltage <0.53mV could predict recurrences of AF with a sensitivity of 94.7% (95% CI 89.3% – 97.8%) and specificity of 8.6% (95% CI 4.6% – 14.8%; PLR 1.04; AUC 0.55). Conclusion Voltage signals in the CS, as a marker for left atrial fibrosis, are associated with the outcome of PVI. A voltage threshold of <0.53mV can predict AF recurrences with a high sensitivity. However, the predictive value for AF recurrences is not high due to the low specificity of this test. FUNDunding Acknowledgement Type of funding sources: None.

Assessing the atrial substrate: electrograms from the coronary sinus can predict left atrial fibrosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Mohsen ◽  
J Draheim ◽  
N Grossmann ◽  
C.H Turan ◽  
M Schoett ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Coronary Sinus ◽  
Left Atrial ◽  
Pearson Correlation ◽  
Atrial Fibrosis ◽  
Atrial Ablation ◽  
Left Atrial Fibrosis ◽  
Diagnostic Catheter

Abstract Background Left atrial fibrosis plays a key role regarding the success rate of pulmonary vein isolation for atrial fibrillation. It can be analyzed using LGE-MRI or invasive LA electroanatomical mapping. Assessing LA substrate prior to performing LA ablation procedures might help in optimizing the ablation approach. Method We analysed highdensity-electroanatomical maps of the left atrium derived by Carto 3 from 282 consecutive atrial fibrillation patients scheduled for RF pulmonary vein isolation (PVI). Maps were divided into 5 different anatomical areas and fibrosis was defined as local voltage <0.5mV. The extent of fibrosis was analyzed and compared with signal recordings from different positions of a diagnostic catheter positioned in the coronary sinus (CS) using Pearson correlation analysis. Results PVI was carried out in 282 patients (male 72%, mean age 63±10.8 years). A minimum of 1000 evenly distributed local electrograms were recorded in every patient. Significant LA fibrosis (>5%) was present in 54% of the patients with the maximum incidence of 100% at the anterior and 80% at the posterior wall. Signal amplituds in the proximal CS position significantly correlated with presence of LA fibrosis in the posterior LA (R 0.84, p<0.001), LA roof (R 0.65; p<0.001), left lateral (R 0.54; p<0.001), septal (R 0.47; p<0.001), and even LA anterior wall (R 0.56; p<0.001). Comparable results were found when using distal CS signals or a signal averaged over all individual CS signals. When used as a diagnostic tool, a CS amplitude <1.9mV could predict fibrosis at the posterior left atrial wall with a specificity of 97% and a sensitivity of 67% (PLR 24, AUC 0.91, 95% CI 0.87 - 0.95; p<0.001). A cut-off value of 1.9mV could be used to identify patients with only minimal LA fibrosis (<5%) with specificity of 88% and a sensitivity of 50% (PLR 4.2, AUC 0.81, 95% CI 0.71–0.89; p<0.001. Conclusion Voltage signals in the CS are significantly associated with presence of fibrosis in all left atrial areas. Moreover, CS voltage signals can be used to identify presence of significant left atrial extrapulmonary vein fibrosis and could help guiding left atrial ablation procedures and choice of ablation technique. Funding Acknowledgement Type of funding source: None

scholarly journals Quantification of Left Atrial Fibrosis in Patients After Pulmonary Vein Isolation Using the Second-Generation Cryoballoon

2021 ◽  
Vol 62 (1) ◽  
pp. 65-71
Author(s):  
Laura Rottner ◽  
Christian-Hendrik Heeger ◽  
Christine Lemes ◽  
Peter Wohlmuth ◽  
Tilman Maurer ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Second Generation ◽  
Atrial Fibrosis ◽  
Left Atrial Fibrosis

scholarly journals Voltage mapping as a method of left atrial fibrosis evaluation

2016 ◽  
Vol 20 (2) ◽  
pp. 111 ◽  
Author(s):  
O. V. Sapelnikov ◽  
Yu. A. Shuvalova ◽  
D. Yu. Cherkashin ◽  
A. A. Krupnov ◽  
A. S. Partigulova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Large Scale ◽  
Atrial Fibrosis ◽  
Instrumental Data ◽  
Voltage Mapping ◽  
Special Software ◽  
Mechanisms Of Development ◽  
Left Atrial Fibrosis ◽  
And Control

<p><strong>Aim:</strong> This pilot study is designed to better understand the mechanisms of development and control of atrial fibrillation.<br /><strong>Methods:</strong> The correlation between fibrosis index (FI), which was calculated intraoperatively with special software, and clinical and instrumental data was analyzed. Also evaluated were FI values as compared to AF catheter ablation outcomes. <br /><strong>Results:</strong> Voltage mapping may be considered as a possible alternative to MRI examination and in some cases it is more informative. <br /><strong>Conclusion:</strong> It was found out that the preliminary results received are a good start for planning a large-scale study in this area related to assessment of the predicative and practical value of the fibrosis index.</p>

scholarly journals ECHOCARDIOGRAPHIC MARKERS OF LEFT ATRIAL FIBROSIS ASSOCIATED WITH THE SEVERITY OF ATRIAL FIBRILLATION

2016 ◽  
Vol 67 (13) ◽  
pp. 1809 ◽  
Author(s):  
Melissa Leung ◽  
Rachid Abou ◽  
Philippe Van Rosendael ◽  
Suzanne Van Wijngaarden ◽  
Madelien Regeer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Atrial Fibrosis ◽  
Left Atrial Fibrosis
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