Left atrial voltage mapping using a new impedance‐based algorithm in patients with paroxysmal atrial fibrillation

Asvestas, Dimitrios; Vlachos, Konstantinos; Bazoukis, George; Martin, Claire; Letsas, Κonstantinos P.; Sakellaropoulou, Antigoni; Kossyvakis, Charalampos; Saplaouras, Athanasios; Prappa, Efstathia; Goga, Christina; Vassilikos, Vassilios; Valkanas, Kosmas; Deftereos, Spyros; Sideris, Antonios; Efremidis, Michael

doi:10.1111/pace.13501

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…The type of mapping catheter 10 and use of TPI may influence the voltage mapping. PentaRay catheters 10 and the TPI algorithm 11 can reduce the LA‐LVA extent compared to conventional methods, and these methods may be more suitable for determining the precise LA‐LVA extent. Fourth, although obstructive sleep apnea has been reported as an independent predictor of the CACS and AF, two‐thirds of the patients were not tested for sleep apnea.…”

Section: Discussionmentioning

confidence: 99%

“…10 A CONFIDENSE mapping module with tissue proximity indication (TPI) feature (Carto 3 Mapping System; Biosense Webster Inc.) was also used (Figure 2). 11 The ratios of the LA-LVA, defined by values greater than 0.5 mV 6,7,12 divided by the total LA surface without PVs, were calculated as LA-LVA (<0.5 mV). According to these voltage maps, patients with LA-LVA (<0.5 mV) greater than 5% 7 were classified as the LVA group, and the remaining patients composed the non-LVA group.…”

Section: Voltage Mapping and Calculation Of The La-lvamentioning

confidence: 99%

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The coronary artery calcium score correlates with left atrial low‐voltage area: Sex differences

Hojo

Fukamizu

Tokioka

et al. 2020

Cardiovasc electrophysiol

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Introduction:In patients with coronary artery disease, a high coronary artery calcium score (CACS) correlates with atrial fibrillation (AF); however, the association between left atrial (LA) remodeling progression and coronary arteriosclerosis is unclear. This study aimed to evaluate the relationship between LA remodeling progression and the CACS. Methods: This retrospective study enrolled 148 patients with AF (paroxysmal AF, n = 94) who underwent catheter ablation. Voltage mapping for the left atrium and coronary computed tomography for CACS calculations were performed. The ratio of the LA low-voltage area (LA-LVA), defined by values less than 0.5 mV divided by the total LA surface without pulmonary veins, was calculated. Patients with LA-LVA (<0.5 mV) >5% and ≤5% were classified as the LVA (n = 30) and non-LVA (n = 118) groups, respectively. Patient characteristics and CACS values were compared between the two groups.Results: LA volume, age, CHA 2 DS 2 VASc score, and percentage of female patients were significantly higher, and the estimated glomerular filtration rate was lower in the LVA group than in the non-LVA group. The CACS was significantly higher in the LVA group (248.4 vs. 13.2; p = .001). Multivariate analysis identified the LA volume index and CACS as independent predictors of LA-LVA (<0.5 mV) greater than 5%.The areas under the receiver operating characteristic curves for predicting LA-LVA (<0.5 mV) greater than 5% with CACS were 0.695 in the entire population, 0.782 in men, and 0.587 in women. Conclusion: Progression of LA remodeling and coronary artery calcification may occur in parallel. A high CACS may indicate advanced LA remodeling, especially in men.

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Section: Discussionmentioning

confidence: 99%

Section: Voltage Mapping and Calculation Of The La-lvamentioning

confidence: 99%

The coronary artery calcium score correlates with left atrial low‐voltage area: Sex differences

Hojo

Fukamizu

Tokioka

et al. 2020

Cardiovasc electrophysiol

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“…The LAA was excluded because it almost never shows LVA and is often a very small structure. The ratio between LVA and total LA surface area (in %) and LVA to LA volume ratio assessed by cCT were calculated [ 4 ].…”

Section: Methodsmentioning

confidence: 99%

“…In previous studies, LA fibrosis was mainly assessed by cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement. CMR uses a different non-invasive method to assess LA fibrosis as compared to invasive 3-dimensional (3D) electroanatomical voltage mapping (EAM) with assessment of bipolar low-voltage areas (LVA), which can be used as a surrogate parameter for myocardial fibrosis [4][5][6][7]. Furthermore, there is previous evidence of the usefulness of targeting LVA to successfully treat AF [8].…”

Section: Introductionmentioning

confidence: 99%

Predictors of left atrial fibrosis in patients with atrial fibrillation referred for catheter ablation

et al. 2022

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“…[36] The evolution of 3D electroanatomic mapping tools and high-density voltage mapping improved the identification of pathological tissue. [37] However, voltage mapping during AF tends to overestimate the extent of underlying atrial fibrosis due to significant differences in electrogram voltage amplitude between sinus rhythm and AF at the same sites among persistent AF patients. [38] The optimal cut-off value for accurate demarcation of left atrial scar displays regional variation, and a bipolar voltage of 0.27 mV best identified atrial scar compared with delayed enhancement cardiac MRI.…”

Section: Impact On Ablation Strategymentioning

confidence: 99%

Atrial Fibrosis: Translational Considerations for the Management of AF Patients

Tzeis

Asvestas

Vardas

2019

Arrhythm Electrophysiol Rev

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Fibrosis plays a fundamental role in the initiation and maintenance of AF, mainly due to enhanced automaticity and anisotropy-related re-entry. The identification and quantification of atrial fibrosis is achieved either preprocedurally by late gadolinium enhancement MRI or intraprocedurally using electroanatomic voltage mapping. The presence and extent of left atrial fibrosis among AF patients may influence relevant decision making regarding the need for anticoagulation, the adoption of rate versus rhythm control and mainly the type of ablation strategy that will be followed during interventional treatment. Several types of individualised substrate modifications targeting atrial fibrotic areas have been proposed, although their impact on patient outcome needs to be further investigated in adequately powered prospective randomised controlled clinical trials.

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Left atrial voltage mapping using a new impedance‐based algorithm in patients with paroxysmal atrial fibrillation

Abstract: A more specific delineation of LA fibrosis may be produced using the TPI feature of the ConfiDense mapping module, through elimination of false-positive annotated mapping points due to low contact.

Cited by 8 publications

References 23 publications

The coronary artery calcium score correlates with left atrial low‐voltage area: Sex differences

The coronary artery calcium score correlates with left atrial low‐voltage area: Sex differences

Predictors of left atrial fibrosis in patients with atrial fibrillation referred for catheter ablation

Atrial Fibrosis: Translational Considerations for the Management of AF Patients

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