High-resolution Mapping in Patients with Persistent AF

Andronache, Marius; Drca, Nikola; Viola, Graziana

doi:10.15420/aer.2018.57.1

Cited by 10 publications

(7 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The start of the century has witnessed the introduction of multielectrode mapping catheters for electroanatomic mapping. 53 Compared with linear, single-point conventional mapping catheters, (Figure 3). 55 The nature of the rhythm is also of critical importance.…”

Section: How Best To Define Abnormal Atrial Substrate: Pitfallsmentioning

confidence: 99%

“…The start of the century has witnessed the introduction of multielectrode mapping catheters for electroanatomic mapping. [ 53 ] Compared with linear, single-point conventional mapping catheters, multielectrode mapping catheters have the combination of smaller electrode size, smaller interelectrode distance and multiple splines. This allows for recording electrograms from a significantly smaller underlying tissue diameter with multiple orientations.…”

Section: How Best To Define Abnormal Atrial Substrate: Pitfallsmentioning

confidence: 99%

“…Moreover, the smaller electrode and closer interelectrode spacing means less signal averages and cancellation effects, which may translate to higher recorded bipolar voltage amplitude with shorter electrogram duration. [ 53 , 54 ] However, the criteria for bipolar low voltage using multielectrode mapping catheters has not been systematically revisited.…”

Section: How Best To Define Abnormal Atrial Substrate: Pitfallsmentioning

confidence: 99%

See 2 more Smart Citations

Atrial Fibrillation Structural Substrates: Aetiology, Identification and Implications

Al‐Kaisey

Lee

Kalman

2020

Arrhythm Electrophysiol Rev

View full text Add to dashboard Cite

AF is the most common sustained cardiac rhythm disorder and is associated with increased morbidity and mortality. Since the first description of AF initiation by triggers from pulmonary veins sleeves, pulmonary vein isolation (PVI) has become the standard ablation strategy in patients with AF. 1 However, freedom from the arrhythmia, particularly in non-paroxysmal AF, remains suboptimal, and it is now clear that, in these patients, AF is maintained by an atrial substrate beyond the pulmonary veins. Although electrical remodelling may be reversible with termination of the arrhythmia, the development of atrial substrate due to fibrosis contributes to the progression of the AF phenotype from paroxysmal to persistent AF, leading to an arrhythmia that is more refractory to intervention. 2 It is clear from animal and human studies that prolonged AF can cause this structural change. Moreover, it is also apparent that a range of risk factors associated with AF, including age, obesity, heart failure (HF), valvular heart disease, hypertension (HT), sleep apnoea and alcohol intake, may also progress atrial remodelling. The rise in the prevalence of cardiovascular risk factors (particularly driven by ageing populations and the obesity epidemic) has been associated with an increase in the prevalence of AF and AF-related hospitalisations. 3 In this review, we focus on insights from electrophysiological mapping studies in cohorts with AF risk factors. We discuss substrate mapping and its implications for AF management and outcomes, and also focus on potential pitfalls. The Second Factor: Structural Remodelling is Required for AF Maintenance Early studies of animal models have demonstrated that AF promotes acute electrical remodelling, which in turn leads to further AF, thereby introducing the seminal concept that 'AF begets AF'. 4-6 In response to either induced AF or rapid atrial pacing, a reduction in the atrial effective refractory period (ERP) occurs with an increase in the spatial heterogeneity of ERP and loss of normal ERP rate adaptation, all resulting in progressively longer durations of AF. In this model, termination of the arrhythmia results in remodelling reversal, suggesting that sinus rhythm may beget sinus rhythm. However, human studies of early intervention to re-establish sinus rhythm do not fully support this concept; the re-establishment of sinus rhythm has not been found to prevent the progression of AF in the majority of patients. 7,8 Ongoing work has indicated that, beyond acute electrical remodelling, structural remodelling also occurs and is not necessarily fully reversible. This socalled second factor has been shown to occur as a result of longer durations of AF. However, the multiple conditions associated with AF also appear to promote significant structural remodelling.

show abstract

Section: How Best To Define Abnormal Atrial Substrate: Pitfallsmentioning

confidence: 99%

Section: How Best To Define Abnormal Atrial Substrate: Pitfallsmentioning

confidence: 99%

Section: How Best To Define Abnormal Atrial Substrate: Pitfallsmentioning

confidence: 99%

See 1 more Smart Citation

Atrial Fibrillation Structural Substrates: Aetiology, Identification and Implications

Al‐Kaisey

Lee

Kalman

2020

Arrhythm Electrophysiol Rev

View full text Add to dashboard Cite

show abstract

“…In several recent studies, left atrial bipolar endocardial voltage maps constructed by acquiring thousands of voltage points by means of 3d‐S 14 have emerged as a tool for defining AF substrates during RF ablation procedures 15 . Indeed, LVZs has been considered a surrogate marker of the presence of atrial fibrosis, and may play a role in giving rise to the mechanisms underlying AF, especially in the case of persistent AF 16,17 .…”

Section: Discussionmentioning

confidence: 99%

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

“…In several recent studies, LA bipolar endocardial voltage maps constructed by acquiring thousands of voltage points by means of 3d-S ( 19) have emerged as a tool for defining AF substrates during RF ablation procedures (20 ). Indeed, LV has been considered a surrogate marker of the presence of atrial fibrosis, and may play a role in giving rise to the mechanisms underlying AF, especially in the case of PsAF (21,22 ).…”

Section: Discussionmentioning

confidence: 99%

A new interpretation of non-pulmonary vein substrates of the left atrium in patients with atrial fibrillation.

Rillo¹,

Palamà²,

Punzi³

et al. 2020

Preprint

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-voltages (LV) through maps constructed by means of various catheters:multipoltar (MC), omnipolar (OC) and circular catheters (CMC) with the 3D electroanatomical systems (3d-S) CARTO3 and Ensite-Precision. Methods. To assess LV we acquired maps by means of CMC and MC in the voltage range 0.05-0.5 mV in 70 patients in sinus rhythm. In case of OC only, we made an intra-patient comparison of bipolar maps constructed in along, across and HD-Wave configurations by means of Ensite-Precision in the ranges of 0.05-0.5 mV and 0.5-1.0 mV. Basing on this comparison, we chose the range that best identified LV and characterized patchy fibrosis by analyzing a set of different colors (qualitative analysis). Finally, we performed a quantitative analysis of LV by applying the qualitative characteristics described above. Results. Basing on our settings, the optimal range for OC was 0.3-0.6 mV. OC revealed smaller LV areas than MC (p <0.05 or p <0.001), except in the lateral wall. No significant differences were observed between CMCs. The same rates of AF recurrence were found for OC and MC during the follow-up period. 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 as LV optimal voltage range.

show abstract

High-resolution Mapping in Patients with Persistent AF

Cited by 10 publications

References 53 publications

Atrial Fibrillation Structural Substrates: Aetiology, Identification and Implications

Atrial Fibrillation Structural Substrates: Aetiology, Identification and Implications

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

A new interpretation of non-pulmonary vein substrates of the left atrium in patients with atrial fibrillation.

Contact Info

Product

Resources

About