scholarly journals The role of high-density mapping in atrial fibrillation ablation

2021 ◽  
Vol 28 (1) ◽  
pp. 33-37
Author(s):  
E. V. Dedukh ◽  
E. A. Artyukhina
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Low Voltage ◽  
Total Surface Area ◽  
High Density ◽  
Interventional Treatment ◽  
Mean Values ◽  
Density Mapping ◽  
Endocardial Mapping

Aims. To determine the role of the prevalence of low-voltage areas in the occurrence of arrhythmia recurrence after interventional treatment of atrial fibrillation (AF).Methods. The study included 38 patients with paroxysmal (52.6%) and persistent (47.4%) forms of AF who underwent interventional treatment of AF using high-density electroanatomical mapping (at least 10,000 EGM points). Analysis of electroanatomical maps was performed after the completion of the ablation procedure. The area of the low-voltage zones was measured manually. Then, the areas of all regions of low-voltage activity were summed up; the resulting value was expressed as a percentage of the total surface area of the left atrium (LA).Results. The observation period was 12.8±3.2 months. Based on the results of endocardial mapping, all patients were divided into 2 groups according to the prevalence of low-voltage areas in the LA. The first group included patients with an area of low-voltage zones less than 5% of the total surface of the left atrium, and the second with an area of low-voltage areas of more than 5% of the total surface of the left atrium. The patients of the first group had a lower LA volume compared to patients from the second group, with mean values of 119.87±16.35 ml and 154.57±33.23 ml, respectively (p=0.007). In the first group, AF recurrence was recorded in one patient after catheter treatment, in the second group in 5 patients.Conclusion. Common areas of low-voltage activity in the left atrium, detected by high-density mapping before the procedure for catheter treatment of AF, are a predictor of arrhythmia recurrence after interventional treatment.

P1037Relationship between left atrium low voltage areas and atrial fibrillation radiofrequency ablation success-rate: preliminary results of the SMOP study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Rordorf ◽  
S Cornara ◽  
L Frigerio ◽  
A Sanzo ◽  
E Chieffo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radio Frequency ◽  
Success Rate ◽  
Left Atrium ◽  
Low Voltage ◽  
Left Ventricular ◽  
High Density ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Short Term

Abstract Background radio frequency catheter ablation (CA) is an effective therapy for atrial fibrillation (AF). Some authors have described a potential relationship between the presence of areas of fibrosis in the left atrium (LA) and the success of CA, nevertheless there is a lack of multicenter studies in this field. Objective the aim of our study was to assess the relationship between the of presence of low voltage areas of the LA detected during subtrate mapping at the time of the procedure and recurrences of AF after CA. Methods we analyzed 214 patients of the SMOP-AF (Substrate Mapping as Outcome Predictor in Atrial Fibrillation Ablation), a prospective multi-centric study enrolling patients with both paroxysmal and persistent AF undergoing a first radio-frequency CA procedure. High-density mapping was performed in sinus rhythm using the CARTO system before performing pulmonary vein isolation. Areas with less than 0,5 mV on mapping were defined as low voltage zone (LVZ), while between 0,5 mV and 1,5 mV intermediate voltage zone (IVZ). IVZ and LVZ were expressed as a percentage of the LA surface. Comparisons were made by Pearson correlation, cross-tables and Chi-square test or Student T test. Results the mean age of the enrolled population was 59±9 years, left ventricular ejection fraction was 59±9%, 86.4% of the pts had tested at least one anti-arrhythmic drug. Persistent atrial fibrillation was present in 10.3% of patients. The rate of documented AF recurrence at 3 months was 15,3% (n=29). There was a statistical significant correlation between the presence of IVZ and the rate of recurrences at 3 months (r=0.16, p value 0.03). Patients with IVZ greater than 4% of the left atrium surface showed a higher risk of recurrences (19.5% vs. 8,7%, p value 0.04). No statistical difference was observed in other procedural variables (number of lesions, contact force, force-time integral) among patients with or without recurrences. Conclusion Our study showed a relationship between CA short-term success rate and the presence of areas of intermediate voltage zone detected with high-density substrate mapping at the time of the procedure. The presence of areas of intermediate voltage zone greater than 4% of the LA determines a 2.5 folds increased risk of short-term recurrence. Our data needs to be confirmed in a longer follow-up.

scholarly journals 525Correlation of left atrial low voltage and fractionation substrate between sinus rhythm and atrial fibrillation: high density mapping study in persistent AF

EP Europace ◽  
2018 ◽  
Vol 20 (suppl_1) ◽  
pp. i100-i101
Author(s):  
J Chen ◽  
A Jadidi ◽  
Z Moreno-Weidmann ◽  
B Mueller-Edenborn ◽  
H Lehrmann ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Low Voltage ◽  
High Density ◽  
Mapping Study ◽  
Density Mapping

scholarly journals Influence of zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias.

2021 ◽  
Author(s):  
Elizaveta Dedukh ◽  
Elena Alexandrovna Artyukhina
Keyword(s):  
Atrial Flutter ◽  
Heart Surgery ◽  
Clinical Observation ◽  
High Density ◽  
Interventional Treatment ◽  
Atrial Arrhythmias ◽  
Density Mapping ◽  
Rf Exposure ◽  
Low Amplitude

Abstract: A clinical case of interventional treatment of a patient with atypical atrial flutter who has not previously undergone surgical or interventional heart surgery. This clinical observation demonstrates the role of common zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias. Widespread areas of low-amplitude activity in the left atrium can create barriers to the propagation of excitation, which can cause atypical atrial flutter. High density mapping will help visualize the mechanism of this arrhythmia. Understanding the mechanism of atypical atrial flutter will help minimize RF exposure during treatment. Key words: high density mapping; atypical atrial flutter; atrial fibrosis; radiofrequency ablation.

P1020Persistent AF patients with limited areas of low voltage have a similar benefit from pulmonary vein isolation as compared to paroxysmal AF patients: insight from the SMOP study

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Frigerio ◽  
A Sanzo ◽  
S Cornara ◽  
E Chieffo ◽  
C La Greca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Statistical Difference ◽  
Low Voltage ◽  
High Density ◽  
P Value ◽  
Atrial Fibrosis ◽  
Density Mapping

Abstract Background Pulmonary vein isolation (PVI) performed with radio-frequency catheter ablation (CA) is an effective therapy for atrial fibrillation (AF). However previous data have suggested that PVI is less effective in persistent (PER) vs. paroxysmal (PAR) AF. Atrial fibrosis and scar, indeed, are an important substrate involved in persistent AF, and some author correlate them to an increased rate of recurrences after CA. For this reason several adjunctive ablation strategies have been suggested for invasive treatment in PER AF pts. However, there is a lack of evidence on their effectivness in current literature. Objective the aim of our study was to assess the rate of AF recurrences in PAR and PER AF patients after a first pulmonary vein isolation (IVP) procedure, and their relationship with low voltage areas of the left atrium assessed by means of high density mapping performed before CA. Methods we analyzed 214 patients of the SMOP-AF study (Substrate Mapping as Outcome Predictor in Atrial Fibrillation Ablation), a prospective multi-centric registry enrolling patients with both PAR and PER AF undergoing a first radio-frequency CA procedure aimed to obtain permanent PVI . High-density mapping was performed in sinus rhythm using the CARTO system before PVI. Areas with less than 0,5 mV on mapping were defined as low voltage zone (LVZ); LVZ was indexed on the atrial area. Comparisons were made by cross-tables and Chi-square test or Student T test. Results Patients with PER AF (n = 44, 21%) were older (63 ± 9 vs 58 ± 10 yrs, p = 0.01), but notably with no difference in LVEF and atrial dimensions as compared to pts with PAR AF. In addition no statistical difference was observed in procedural variables, except for a greater LVZ area on atrial mapping (8 ± 18 % vs. 5 ± 15 %, p = 0.04) and a longer p wave duration (115 ± 21 msec vs. 103 ± 18 msec, p = 0.01) in pts with PER AF. The incidence of recurrence in the overall population was 15.3% at 3 months and 13.7% from 3 to 12 months: there was no statistical difference in success-rate between PER and PAR pts (respectively 79,5% vs 86% p value = 0.315 in blanking period and 85,3% vs 86,5% p value = 0.8 at 3-12 months follow-up). No statistical difference was observed for ablation variables (number of lesion, contact force, force time integral) in pts with vs. without recurrences. Conclusion Our study showed that pulmonary vein isolation alone seems to be as effective in paroxismal and persistent AF patients with low degree of left atrial fibrosis. Our data call into question the idea that PVI alone is not effective in PER AF. High density mapping of the LA could help to identify a subset of PER AF patients with a limited extension of low voltage areas (i.e around 10% of the overall LA surface) that could benefit from PVI without adjunctive ablation strategies. Our data needs to be confirmed in a longer follow-up.

scholarly journals Electrical anatomy of the left atrium during atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Adragao ◽  
D Nascimento Matos ◽  
F Costa ◽  
P Galvao Santos ◽  
G Rodrigues ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Refractory Period ◽  
Cycle Length ◽  
Low Voltage ◽  
Pulmonary Veins ◽  
Density Mapping ◽  
Superior Pulmonary Vein

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Twenty years ago, pulmonary veins (PV) ostia were identified as the left atrium (LA) areas with the shortest refractory period during sinus rhythm. Pulmonary veins isolation (PVI) became standard of care, but clinical results are still suboptimal. Today, a special tool using the Carto® electroanatomical mapping (EAM) allows for AF cycle length mapping (CLM), to identify the areas in the left atria with shortest refractory period, during atrial fibrillation. Using this EAM tool, our study aimed to find the LA areas with the shortest refractory period to better recognize electrical targets for catheter ablation. Methods Retrospective analysis of an unicentric registry of individuals with symptomatic drug-refractory AF who underwent PVI with Carto® EAM. CLM was performed with a high-density mapping Pentaray® catheter before and after PVI and in 4 redo procedures. We assessed areas of short cycle length (SCL) (defined as 120 to 250ms), and their relationships with complex fractionated atrial electrograms (CFAE), and low-voltage zones (from 0.1 to 0.3mV). Results A total of 18 patients (8 men, median age 63 IQR 58-71 years) were included. Most patients presented with persistent AF (n = 12, 67%), and 4 patients (22%) had a previous PVI. The mean shortest measured cycle length in AF was 140ms (SD ±27ms). All patients presented areas of SCL located in the PVs or their insertion, 70% in the posterior/roof region adjacent to the left superior pulmonary vein (LSPV) (figure 1) and 60% in the anterior region of the right superior pulmonary vein (RSPV). These two areas remained the fastest even after PVI. The anterior mitral region rarely presented SCL (17%). SCL were related to low-voltage areas in 94% and were adjacent to CFAE. Low-voltage areas and CFAE were more frequent and had a larger LA dispersion than SCL. Conclusion   We confirmed in 3D mapping that PVs are the LA zones with shortest refractory period, not only in sinus rhythm but also during AF. The persistence of SCL areas in the border zones of the PVI lines suggest the benefit of a more extensive CLM guided ablation. Larger studies are needed. Abstract Figure 1

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