Discrepancy between CARTO and Rhythmia maps for defining the left atrial low-voltage areas in atrial fibrillation ablation

Kaseno, Kenichi; Hasegawa, Kanae; Miyazaki, Shinsuke; Mukai, Moe; Aoyama, Daisetsu; Nodera, Minoru; Hirano, Koudai; Otake, Mika; Nomura, Ryouhei; Miyahara, Kosuke; Ishikawa, Rie; Matsui, Akira; Yamaguchi, Junya; Shiomi, Yuichiro; Takahashi, Naoto; Ikeda, Hiroyuki; Fukuoka, Yoshitomo; Ishida, Kentaro; Uzui, Hiroyasu; Tada, Hiroshi

doi:10.1007/s00380-021-01773-7

Cited by 10 publications

(11 citation statements)

References 14 publications

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“…However, the described variability of BEAM is most likely a universal phenomenon unrelated to the system used. In fact, we use the CARTO 3 system because in our opinion it provides the greatest map reliability, which has been confirmed previously 16 …”

Section: Discussionsupporting

confidence: 70%

“…While high‐density mapping using smaller electrodes may reduce the observed variability, observations so far indicate that it will not be completely eliminated (Figure 3B,B1). 16 The observed variability of measurements in biological systems is not unusual. Since it is not known which of the measured values represents the “true” value, averaging several measurements can produce more reliable and reproducible results.…”

Section: Discussionmentioning

confidence: 99%

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Atrial electrogram amplitude variability during atrial fibrillation ablation

Hangiel

Kuśnierz²,

Bardyszewski³

et al. 2022

Cardiovasc electrophysiol

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Introduction Variability of the bipolar atrial electrogram amplitude may affect voltage maps created during ablation procedures, and thus also the extent of ablations. Therefore, the aim of the study was to assess the beat‐to‐beat electrogram amplitude variability in the left atrium in patients undergoing atrial fibrillation ablation. Methods In 11 patients undergoing ablation for atrial fibrillation, 362 mapping points were collected in two series. At each point, three consecutive beats were recorded and verified including the bipolar electrogram amplitude, contact force (CF), and orientation of the catheter tip. The repeatability and reproducibility of obtained measurements between consecutive beats and series were assessed by the Pearson correlation coefficient (r), the Bland‐Altman test, repeatability coefficient (RC), relative standard deviation (RSD), and concordance correlation coefficient (CCC). Results A total of 1086 beats were analyzed. The correlation coefficient for bipolar atrial electrogram amplitude for the first two beats, and for the first and the third beats were 0.94 and 0.86, respectively. The average of differences between the first two beats and between the first and the third beats were 0.06 and 0.13 mV with 95% limits of agreement (LoA) within ±0.98 and ±1.74 mV, respectively. For CF values ≤5 and ≥20 g, the 95% LoA were narrower compared to other CF ranges and were ±0.49 and ±0.71 mV from the average value, respectively. When the analyzes were performed within the predefined ranges of bipolar electrogram amplitude: 0.05–1; 1–2; 2–3 mV, the 95% LoA were within ±0.33, ±0.98, and ±0.84 mV from the average value, respectively. RC and RSD were 1.41 mV and 20.8%, respectively. For repeated measurement between series, CCC ranged from 0.67 to 0.71 and the 95% LoA were within ±2.7 to 2.9 mV from the average value. Conclusion Bipolar atrial electrogram amplitude recorded at a given site during ablation procedures is variable to an extent that may be clinically relevant. The magnitude of the observed variability is greater during remapping.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Atrial electrogram amplitude variability during atrial fibrillation ablation

Hangiel

Kuśnierz²,

Bardyszewski³

et al. 2022

Cardiovasc electrophysiol

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“…Although there is a lack of literature comparing catheters, there is data on comparing PC with Orion (Boston Scientific), which is a multielectrode catheter similar to PC. It has been reported that PC could be able to record more potentials and reduce LVA 7 . A previous study compared between GMC and circular catheters, reporting a higher potential acquisition by GMC with less LVA 8 .…”

Section: Discussionmentioning

confidence: 98%

“…It has been reported that PC could be able to record more potentials and reduce LVA. 7 A previous study compared between GMC and circular catheters, reporting a higher potential acquisition by GMC with less LVA. 8 Therefore, both GMC and PC were considered as electrode catheters that allow for more detailed mapping.…”

Section: Discussionmentioning

confidence: 99%

Grid‐mapping catheters versus PentaRay catheters for left atrial mapping on ensite precision mapping system

Saito

Yamashita

Numajiri

et al. 2022

Cardiovasc electrophysiol

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Introduction: Areas displaying reduced bipolar voltage are defined as low-voltage areas (LVAs). Moreover, left atrial (LA) LVAs after pulmonary vein isolation (PVI) have been reported as a predictor of recurrent atrial fibrillation (AF). In this study, we compared grid mapping catheter (GMC) with PentaRay catheter (PC) for LA voltage mapping on Ensite Precision mapping system.Methods: Twenty-six consecutive patients with LVAs and border zone within the LA were enrolled. After achieving PVI, voltage mapping under high right atrial pacing for 600 ms was performed twice using each catheter type (GMC first, PC next).Furthermore, LVA was defined as a region with a bipolar voltage of <0.50, and border zone was defined as a region with a bipolar voltage of <1.0, or <1.5 mV.Results: Compared with PC, using GMC, voltage mapping contained more mapping points (20 242 [15 859, 26 013] vs. 5589 [4088, 7649]; p < .0001), and more mapping points per minute (1428 [1275, 1803] vs. 558 [372, 783]; p < .0001). In addition, LVA and border zone size using GMC was significantly less than that reported using PC: <1.0 mV (5.9 cm 2 [2.9, 20.2] vs. 13.9 cm 2 [6.3, 24.1], p = .018) and <1.5 mV voltage cutoff (10.6 cm 2 [6.6, 27.2] vs. 21.6 cm 2 [12.6, 35.0], p = .005). Conclusion:Bipolar voltage amplitude estimated by GMC was significantly larger than that estimated by PC on Ensite Precision mapping system. GMC may be able to find highly selective identification of LVAs with lower prevalence and smaller LVA and border zone size.

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“…They elegantly showed that mapping with small closely spaced electrode catheters could improve the mapping resolution within low voltage areas. Kaseno et al 3 compared the left atrial voltage maps created with the PC on the CARTO3 system and those created with a mini‐basket catheter consisting of 64 electrodes (electrode size of 0.4 mm 2 with an interelectrode spacing of 2.5 mm) (Orion; Boston Scientific) on the Rhythmia system, in AF patients. They concluded that the average low voltage areas were comparable but there was a discrepancy in some patients.…”

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confidence: 99%