Spatial Relationship of Focal Impulses, Rotors and Low Voltage Zones in Patients With Persistent Atrial Fibrillation

Atrial fibrillation (AF) despite the absence of heart failure is related to increased levels of natriuretic peptides (NPs). NPs have not been widely investigated in relation to left atrium (LA) function after sinus rhythm (SR) restoration and duration of AF. The aim of the study was to determine the changes of NPs levels and to define their relation with LA phasic function after electrical cardioversion (ECV). Methods. The study included 48 persistent AF patients with restored SR after ECV. NT-proANP and NT-proBNP were measured for all patients before the ECV. LA phasic function (reservoir, conduit, and pump phases) was assessed using echocardiographic volumetric analysis within the first 24 hours after ECV. Patients were repeatedly tested after 1 month in case of SR maintenance. Results. After 1 month, SR was maintained in 26 (54%) patients. For those patients, NT-proBNP decreased significantly (p=0.0001), whereas NT-proANP tended to decrease (p=0.13). Following 1 month after SR restoration, LA indexed volume decreased (p=0.0001) and all phases of LA function improved (p=<0.01). Patients with AF duration < 3 months had lower NT-proANP compared to patients with AF duration from 6 to 12 months (p = 0.005). Higher NT-proANP concentration before ECV was associated with lower LA reservoir function during the first day after SR restoration (R=-0.456, p=0.005), whereas higher NT-proBNP concentration after 1 month in SR was significantly related to lower LA reservoir function (R=-0.429, p=0.047). Conclusions. LA indexed volume, all phases of LA function, and NT-proBNP levels improved significantly following 1 month of SR restoration. Preliminary results suggest that higher baseline NT-proANP levels and higher NT-proBNP for patients with maintained SR for 1 month are related to lower LA reservoir function. The longer duration of persistent AF is associated with higher NT-proANP concentration.

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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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Catheter Ablation of Low-Voltage Areas for Persistent Atrial Fibrillation: Procedural Outcomes Using High-Density Voltage Mapping

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2020.03.040 ◽

2020 ◽

Vol 36 (12) ◽

pp. 1956-1964 ◽

Cited By ~ 1

Author(s):

Pablo B. Nery ◽

Wael Alqarawi ◽

Girish M. Nair ◽

Mouhannad M. Sadek ◽

Calum J. Redpath ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Low Voltage ◽

Persistent Atrial Fibrillation ◽

High Density ◽

Voltage Mapping ◽

Procedural Outcomes

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P6593Atrial low voltage zone as a novel predictor of sinus node dysfunction in patients with persistent atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehy566.p6593 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

T Kondo ◽

M Kimura ◽

M Nakayama ◽

O Matsuda

Keyword(s):

Atrial Fibrillation ◽

Low Voltage ◽

Sinus Node ◽

Persistent Atrial Fibrillation ◽

Sinus Node Dysfunction

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GW29-e0824 Correlation of left atrial low voltage and fractionation substrate between sinus rhythm and atrial fibrillation: high density mapping study in persistent Atrial Fibrillation

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.670 ◽

2018 ◽

Vol 72 (16) ◽

pp. C144-C145

Author(s):

Juan Chen ◽

Amir Jadidi

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrial ◽

Low Voltage ◽

Persistent Atrial Fibrillation ◽

High Density ◽

Mapping Study ◽

Density Mapping

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Substrate mapping of the left atrium in persistent atrial fibrillation: spatial correlation of localized complex conduction patterns in global charge-density maps to low-voltage areas in 3D contact bipolar voltage maps

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-020-00926-4 ◽

2021 ◽

Author(s):

Gian-Battista Chierchia ◽

Juan Sieira ◽

Annelies Vanderper ◽

Thiago Guimarães Osorio ◽

Gezim Bala ◽

...

Keyword(s):

Charge Density ◽

Left Atrium ◽

Low Voltage ◽

Spatial Relationship ◽

Persistent Atrial Fibrillation ◽

Bipolar Voltage ◽

Density Maps ◽

History Of ◽

Composite Maps ◽

The Moment

Abstract Purpose This study aimed to investigate the spatial relationship between low-voltage areas (LVAs) in bipolar voltage mapping (BVM) and localized complex conduction (LCC)-cores in a global, non-contact, charge-density-based imaging, and mapping system (AcM). Methods Patients with history of index PVI for PsAF and scheduled for a repeat ablation procedure for recurrence of the same arrhythmia were enrolled between August 2018 and February 2020. All patients underwent both substrate mappings of the left atrium (LA) with the CARTO 3D map-ping system and with AcM. Results Ten patients where included in our analysis. All presented with persistency of PVI in all veins at the moment of repeat procedure. There was no linear relationship in BVM maps between SR and CSd (correlation coefficient 0.31 ± 0.15), SR and CSp (0.36 ± 0.12) and CSd and CSp (0.43 ± 0.10). The % overlap of localized irregular activation (LIA), localized rotational activation (LRA) and Focal (F) regions with LVA was lower at 0.2 mV compared to 0.5 mV (4.97 ± 7.39%, 3.27 ± 5.25%, 1.09 ± 1.92% and 12.59 ± 11.81%, 7.8 ± 9.20%, 4.62 ± 5.27%). Sensitivity and specificity are not significantly different when comparing composite maps with different LVA cut-offs. AURC was 0.46, 0.48, and 0.39 for LIA, LRA, and Focal, respectively. Conclusion Due to wave front direction dependency, LVAs mapped with BVM in sinus rhythm and during coronary sinus pacing only partially overlap in patients with PsAF. LCC-cores mapped during PsAF partially co-localize with LVAs.

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