Bipolar Voltage Mapping for the Evaluation of Atrial Substrate: Can We Overcome the Challenge of Directionality?

Yamaguchi, Takanori; Fukui, Atsushi; Node, Koichi

doi:10.4022/jafib.2116

Cited by 29 publications

(18 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First of all, the 0.5 mV threshold was arbitrarily chosen with no previous histological correlation. Despite this, conduction velocity in areas with a bipolar voltage between 0.5 mV and 1 mV seems to resemble that of the non-LVZs areas and fractioned electrograms were found exactly in these areas of <0.5 mV [44]. Moreover, these areas were associated with arrhythmia inducibility.…”

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 87%

“…Another possible method for quantifying the atrial substrate and, indirectly, estimate the fibrotic burden, is three-dimensional electroanatomic mapping (EAM) systems bipolar voltage mapping, used in clinical practice to guide ablation procedures [44,45]. Low-voltage zones (LVZ) were arbitrarily defined as areas of a bipolar voltage of <0.5 mV, while silent areas (scars) translated into either no detection of electrical activity or a bipolar voltage of < 0.05 mV.…”

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 99%

“…Low-voltage zones (LVZ) were arbitrarily defined as areas of a bipolar voltage of <0.5 mV, while silent areas (scars) translated into either no detection of electrical activity or a bipolar voltage of < 0.05 mV. Although several studies showed that patients presenting with increased LVZs (stages III and IV) present with increased post-ablation arrhythmic recurrences [44,46], there are several controversies regarding this technique.…”

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 99%

“…While Oakes et al reported that LGE correlated with LVZ defined as a bipolar voltage of <0.5 mV and provided histological evidence [21], Lim et al point out that both techniques lack agreement in protocols and are difficult to compare [47]. Moreover, a mismatch has been reported between LGE and LVZ distribution within the LA [44]. While LGE was most frequently found in the posterior, lateral and inferior LA walls, LVZ was identified in the anterior wall, roof and interatrial septum [44].…”

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 99%

“…Moreover, a mismatch has been reported between LGE and LVZ distribution within the LA [44]. While LGE was most frequently found in the posterior, lateral and inferior LA walls, LVZ was identified in the anterior wall, roof and interatrial septum [44]. Interestingly, in the study conducted by Platonov et al evaluating histological LA fibrosis, the LA anterior wall and septum were not examined [48].…”

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 99%

See 4 more Smart Citations

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

et al. 2020

View full text Add to dashboard Cite

Left atrial structural, functional and electrical remodelling are linked to atrial fibrillation (AF) pathophysiology and mirror the phrase “AF begets AF”. A structurally remodelled left atrium (LA) is fibrotic, dysfunctional and enlarged. Fibrosis is the hallmark of LA structural remodelling and is associated with increased risk of stroke, heart failure development and/or progression and poorer catheter ablation outcomes with increased recurrence rates. Moreover, increased atrial fibrosis has been associated with higher rates of stroke even in sinus-rhythm individuals. As such, properly assessing the fibrotic atrial cardiomyopathy in AF patients becomes necessary. In this respect, late-gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard in imaging myocardial fibrosis. LA structural remodelling extension offers both diagnostic and prognostic information and influences therapeutic choices. LGE-CMR scans can be used before the procedure to better select candidates and to aid in choosing the ablation technique, during the procedure (full CMR-guided ablations) and after the ablation (to assess the ablation scar). This review focuses on imaging several LA structural remodelling CMR parameters, including size, shape and fibrosis (both extension and architecture) and their impact on procedure outcomes, recurrence risk, as well as their utility in relation to the index procedure timing.

show abstract

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 87%

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 99%

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 99%

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 99%

Section: Left Atrial Fibrosis and Electroanatomic Mappingmentioning

confidence: 99%

See 3 more Smart Citations

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

et al. 2020

View full text Add to dashboard Cite

show abstract

A new interpretation of nonpulmonary vein substrates of the left atrium in patients with atrial fibrillation

Rillo

Palamà

Punzi

et al. 2021

Journal of Arrhythmia

View full text Add to dashboard Cite

Background Substrate analysis of the left atrium in patients undergoing atrial fibrillation ablation has limitations when performed by means of simple bipolar acquisition. Objective To evaluate the incidence of low‐voltage zones (LVZs) through maps constructed by means of various catheters: multipolar (MC), omnipolar (OC), and circular catheters (CMCs) with the 3D electro‐anatomical systems (3d‐S) CARTO3 and EnSite Precision. Methods To assess LVZs, we acquired maps by means of CMC and MC in the voltage range 0.05‐0.5 mV in 70 consecutive patients in sinus rhythm. In the case of OC only, we made an intra‐patient comparison of bipolar maps constructed by means of the along and across, and HD‐Wave configurations of the EnSite 3d‐S in the ranges of 0.05‐0.5 and 0.5‐1.0 mV. On the basis of this comparison, we chose the range that best identified LVZs as a set of different colors (SDC) compatible with patchy fibrosis (qualitative analysis). Subsequently, we detected the voltage values corresponding to purple and gray points, close to SDC, and the value inside corresponding to blue, green, and red colors, and we evaluated the color change in other voltage ranges. Finally, we performed a quantitative analysis of LVZs by applying the qualitative characteristics described above. Results On the basis of our settings, for OC, the optimal range identifying LVZs was 0.3‐0.6 mV. OC revealed smaller LVZs than MC (P < .05 or P < .001), except in the lateral wall. No significant differences were observed between CMCs. Conclusions In our experience, OC does not present the limits of bipolar HD maps, though further studies are needed in order to confirm that 0.3‐0.6 mV is the optimal voltage range within which to identify LVZs.

show abstract

Predictors of recurrence of atrial tachyarrhythmias after pulmonary vein isolation by functional and structural mapping of nonparoxysmal atrial fibrillation

Kumagai

Sato

Kurose

et al. 2021

Journal of Arrhythmia

View full text Add to dashboard Cite

Background This study aimed to evaluate the predictors of recurrence of atrial tachyarrhythmias by structural and functional mapping: voltage, dominant frequency (DF), and rotor mapping after a pulmonary vein isolation (PVI) in nonparoxysmal atrial fibrillation (AF) patients. Methods A total of 66 nonparoxysmal AF patients were prospectively investigated. After the PVI, an online real‐time phase mapping system was used to detect the location of rotors with critical nonpassively activated ratios (%NPs) of ≧50% in each left atrial (LA) segment, and high‐DFs of ≧7 Hz were simultaneously mapped. After restoring sinus rhythm, low‐voltage areas (LVAs < 0.5 mV) were mapped using the Advisor HD grid catheter (HDG). Results Sixty‐four of 66 (97%) AF patients had minimum to mild LVAs regardless of an enlarged LAD and LA volume (45 ± 6.0 mm and 141 ± 29 ml). There were no significant differences in the max and mean DF values and %NPs between the patients with and without recurrent atrial tachyarrhythmias. However, there was a significant difference in the LVA/LA surface area between the patients with and without recurrent atrial tachyarrhythmias (p = .004). Atrial tachyarrhythmia freedom was significantly greater in those with LVAs of ≤3.3% than in those >3.3% after one procedure over 11.6 ± 0.8 months of follow‐up (77.1% vs. 33.3%, p < .001). In a multivariate analysis, the LVA/LA surface area after the PVI (HR 1.079; CI, 1.025–1.135, p = .003) was an independent predictor of AF recurrence. Conclusions The predictor of atrial tachyarrhythmia recurrence after the PVI was LVAs rather than DFs and rotors in nonparoxysmal AF patients.

show abstract

Bipolar Voltage Mapping for the Evaluation of Atrial Substrate: Can We Overcome the Challenge of Directionality?

Cited by 29 publications

References 39 publications

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

A new interpretation of nonpulmonary vein substrates of the left atrium in patients with atrial fibrillation

Predictors of recurrence of atrial tachyarrhythmias after pulmonary vein isolation by functional and structural mapping of nonparoxysmal atrial fibrillation

Contact Info

Product

Resources

About