Correlation between Cardiac MRI and Voltage Mapping in Evaluating Atrial Fibrosis: A Systematic Review

Bijvoet, Geertruida P.; Nies, Hedwig M J M; Holtackers, Robert J.; Linz, Dominik; Adriaans, Bouke P.; Nijveldt, Robin; Wildberger, Joachim E.; Vernooy, Kevin; Chaldoupi, Sevasti‐Maria; Mihl, Casper

doi:10.1148/ryct.220061

Cited by 12 publications

(10 citation statements)

References 38 publications

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“…Most of these studies included ablation naïve patients with a high percentage of healthy atrial tissue 6,10 . Our study cohort of pre‐ablated patients is on average older, has a longer AF duration, and a higher percentage of atrial myopathy than reported in most other studies 14 . All patients in our cohort were mapped with the help of a multipolar basket catheter and an ultrahigh‐definition mapping system.…”

Section: Discussionmentioning

confidence: 99%

“…6,10 Our study cohort of pre-ablated patients is on average older, has a longer AF duration, and a higher percentage of atrial myopathy than reported in most other studies. 14 All patients in our cohort were mapped with the help of a multipolar basket catheter and an ultrahigh-definition mapping system. Maps were aimed at a complete imaging of the left atrium.…”

Section: Patients With and Without Re-pvimentioning

confidence: 99%

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Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures

Georgi,

Bannehr,

Lochmann

et al. 2024

Cardiovasc electrophysiol

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IntroductionLeft atrial (LA) low voltage areas (LVA) are a controversial target in atrial fibrillation ablation procedures. However, LVA and LA volume are good predictors of arrhythmia recurrence in ablation‐naïve patients. Their predictive value in progressively diseased pre‐ablated atria is uncertain.MethodsConsecutive patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT), who were scheduled for repeat LA ablation, were enrolled in the prospective Bernau ablation registry between 2016 and 2020. All patients received a complete LA ultrahigh‐density map before ablation. Maps were analyzed for LA size, LVA percentage and distribution. The predictive value of demographic, anatomic, and mapping variables on AF recurrence was analyzed.Results160 patients (50.6% male, 1.3 pre‐ablations, 60% persistent AF) with complete LA voltage maps were included. Mean follow‐up time was 16 ± 11 months. Mean recorded electrograms (EGMs) per map were 9754 ± 5808, mean LA volume was 176.1 ± 35.9 ml and mean rate of LVAs <0.5 mV was 30.6% ± 23.1%. During follow‐up recurrence rate of AF or AT >30 s was 55.6%. Patients with recurrence had a significant higher percentage of LVAs (40.0% vs. 18.8%, p < .001) but no relevant difference in LA volume (172 vs. 178 mL, p = .299). ROC curves revealed LVA as a good predictor for recurrence (AUC = 0.79, p < .001) and a cut‐off of 22% LVAs with highest sensitivity (73.0%) and specificity (71.8%). Based on this cut off, event free survival was significantly higher in the Low LVA group (p < .01).ConclusionTotal LVA percentage has a good predictive power on arrhythmia recurrence in a cohort of advanced scarred left atria in repeat procedures independent of the applied ablation strategy. Left atrial volume seems to have minor impact on the rhythm outcome in our study cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Patients With and Without Re-pvimentioning

confidence: 99%

Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures

Georgi,

Bannehr,

Lochmann

et al. 2024

Cardiovasc electrophysiol

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“…As histological validation of electrogram voltages with fibrosis has not been studied, one non-invasive method of investigating this relationship uses signal intensity of LGE-MRI. A recent meta-analysis noted 19 of 22 studies found a significant correlation between LGE signal intensity and low voltage areas, however the analysis also highlighted a large heterogeneity between studies, hampering interpretation of the results [ 17 ]. Curiously however, in the only study comparing 3D EAMs in both SR and AF to LGE-MRI within the same patient, Quereshi et al found a significant correlation between LGE signal intensity and bipolar voltages in AF, but not in SR [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of voltages between atria: differences in sinus rhythm and atrial fibrillation

Bates,

Paisey,

Yue

et al. 2023

J Interv Card Electrophysiol

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Background Ultra high-density mapping systems allow for comparison of atrial electroanatomical maps in unprecedented detail. Atrial scar determined by voltages and surface area between atria, rhythm and atrial fibrillation (AF) types was assessed. Methods Left (LA) and right atrial (RA) maps were created using Rhythmia HDx in patients listed for ablation for paroxysmal (PAF, sinus rhythm (SR) maps only) or persistent AF (PeAF, AF and SR maps). Electrograms on corresponding SR/AF maps were paired for direct comparison. Percentage surface area of scar was assigned low- (LVM, ≤ 0.05 mV), intermediate- (IVM, 0.05–0.5 mV) or normal voltage myocardium, (NVM, > 0.5 mV). Results Thirty-eight patients were recruited generating 96 maps using 913,480 electrograms. Paired SR-AF bipolar electrograms showed fair correlation in LA (Spearman’s ρ = 0.32) and weak correlation in RA (ρ = 0.19) and were significantly higher in SR in both (LA: 0.61 mV (0.20–1.67) vs 0.31 mV (0.10–0.74), RA: 0.68 mV (0.19–1.88) vs 0.47 mV (0.14–1.07), p < 0.0005 both). Voltages were significantly higher in patients with PAF over PeAF, (LA: 1.13 mV (0.39–2.93) vs 0.52 mV (0.16–1.49); RA: 0.93 mV (0.24–2.46) vs 0.57 mV (0.17–1.69)). Minimal differences were seen in electrogram voltages between atria. Significantly more IVM/LVM surface areas were seen in AF over SR (LA only, p < 0005), and PeAF over PAF (LA: p = 0.01, RA: p = 0.04). There was minimal difference between atria within patients. Conclusions Ultra high-density mapping shows paired electrograms correlate poorly between SR and AF. SR electrograms are typically (but not always) larger than those in AF. Patients with PeAF have a lower global electrogram voltage than those with PAF. Electrogram voltages are similar between atria within individual patients.

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“…The main advantage over late gadolinium enhancement is that T1 mapping MRI does not require contrast and allows a quantitative measurement of features such as diffuse fibrosis, a reason why it has recently been used to detect this type of fibrosis [ 14 ]. Scar can also be quantified with electroanatomical mapping, as low-voltage areas have been shown to correlate with scar in both ventricles [ 15 ] and atria [ 16 ], although transmurality information is limited. Finally, the quantification of thin areas of the ventricular wall on CT with delayed enhancement has been correlated with areas with low voltage on electroanatomical mapping, but this is not widely used in clinical practise to identify scar tissue [ 17 ].…”

Section: Experimental and Clinical Data Used In Anatomical And Mechan...mentioning

confidence: 99%

Advancing clinical translation of cardiac biomechanics models: a comprehensive review, applications and future pathways

Rodero,

Baptiste,

Barrows

et al. 2023

Front. Phys.

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Cardiac mechanics models are developed to represent a high level of detail, including refined anatomies, accurate cell mechanics models, and platforms to link microscale physiology to whole-organ function. However, cardiac biomechanics models still have limited clinical translation. In this review, we provide a picture of cardiac mechanics models, focusing on their clinical translation. We review the main experimental and clinical data used in cardiac models, as well as the steps followed in the literature to generate anatomical meshes ready for simulations. We describe the main models in active and passive mechanics and the different lumped parameter models to represent the circulatory system. Lastly, we provide a summary of the state-of-the-art in terms of ventricular, atrial, and four-chamber cardiac biomechanics models. We discuss the steps that may facilitate clinical translation of the biomechanics models we describe. A well-established software to simulate cardiac biomechanics is lacking, with all available platforms involving different levels of documentation, learning curves, accessibility, and cost. Furthermore, there is no regulatory framework that clearly outlines the verification and validation requirements a model has to satisfy in order to be reliably used in applications. Finally, better integration with increasingly rich clinical and/or experimental datasets as well as machine learning techniques to reduce computational costs might increase model reliability at feasible resources. Cardiac biomechanics models provide excellent opportunities to be integrated into clinical workflows, but more refinement and careful validation against clinical data are needed to improve their credibility. In addition, in each context of use, model complexity must be balanced with the associated high computational cost of running these models.

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Correlation between Cardiac MRI and Voltage Mapping in Evaluating Atrial Fibrosis: A Systematic Review

Cited by 12 publications

References 38 publications

Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures

Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures

Comparison of voltages between atria: differences in sinus rhythm and atrial fibrillation

Advancing clinical translation of cardiac biomechanics models: a comprehensive review, applications and future pathways

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