Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation

Huo, Yan; Gaspar, Thomas; Pohl, Matthias; Sitzy, J; Richter, U; Neudeck, Sebastian; Mayer, Julia; Kronborg, Mads Brix; Piorkowski, Christopher

doi:10.1093/europace/eux082

Cited by 91 publications

(101 citation statements)

References 18 publications

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“…Mapping was performed as previously reported 4,8 . In brief, a HD‐BVM map (LVZ <0.5 mV) was created simultaneously with LA surface reconstruction, guided by a three‐dimensional electroanatomical mapping system (CARTO3, Biosense Webster, or Ensite Precision, Abbott) using a circular mapping catheter (Lasso, 4 mm interelectrode spacing, Biosense Webster, or Advisor FL, 3 mm interelectrode spacing, Abbott).…”

Section: Methodsmentioning

confidence: 99%

“…For each mapping point, stable contact between the local atrial tissue and each pair of electrodes of the circular mapping catheter was required. Extra care was taken while collecting voltage points on the border of LVZ 4 …”

Section: Methodsmentioning

confidence: 99%

“…Additional extra PV ablation was individualized based on the voltage maps where LVZ substrates were targeted with (a) homogenization of small LVZs, (b) linear lesions connecting LVZs to anatomical obstacles (eg, PVs, or mitral annulus [MA]), and (c) linear lesions isolating large LVZs (eg, isolation of the posterior LA wall). Ablation endpoints were (a) lack of local pace capture and (b) bidirectional conduction block over linear lesions 4,5,8 …”

Section: Methodsmentioning

confidence: 99%

“…Presence of low voltage zones (LVZ) in the left atrium (LA) during high‐density bipolar voltage mapping (HD‐BVM) indicates fibrofatty infiltration which is an important determinant for initiation and maintenance of atrial fibrillation (AF) 1‐3 . Spontaneous fibrofatty transformation is thought to be a progressive process that increases over time and is associated with age and comorbidity such as hypertension, diabetes, and heart failure 4 …”

Section: Introductionmentioning

confidence: 99%

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Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information

Kronborg

Richter

Guo

et al. 2020

Cardiovasc electrophysiol

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Background Left atrial substrate modification targeting low voltage zones (LVZ) is an ablation strategy that—in addition to pulmonary vein (PV) isolation—tries to eliminate arrhythmogenic mechanisms harbored in such tissue. Electrophysiological findings at reablation include (a) PV reconnection, (b) reconnection over previous substrate ablation, and (c) de‐novo LVZ. Objective To study, prevalence and contribution of these arrhythmogenic electrophysiological entities in patients with atrial fibrillation (AF) recurrences. Methods Consecutive patients with highly symptomatic AF undergoing index and reablation were included (n = 113). In all patients' PV reconnection, reconnection over previous substrate ablation and spontaneous de‐novo LVZ were quantitatively assessed and integrated into an individual reablation strategy. Follow‐up was based on continuous device monitoring. Results At re‐do procedure, 45 out of 113 (39.8%) patients showed PV reconnection as the only electrophysiological abnormality. Reconduction over previous lines was the only electrophysiological abnormality in 8 out of 113 (7.1%) patients. Spontaneous de‐novo LVZ was the only electrophysiological abnormality in 12 out of 113 (10.6%) patients. Combined findings of PV reconnection, line reconduction, and/or spontaneous de‐novo LVZ were seen in 40 out of 113 (35.4%) patients. No detectable electrophysiological abnormality was observed in 8 out of 113 (7.1%) patients. In univariate analysis, none of the tested electrophysiological characteristics independently predicted the outcome after re‐do. Conclusions In patients undergoing reablation, we could show that reconduction over previous substrate ablation as well as the development of new low voltage areas are frequent findings besides classical PV reconnection—without a clear leading cause for recurrences. These findings impact reablation strategies as well as the strategic focus during index procedures.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information

Kronborg

Richter

Guo

et al. 2020

Cardiovasc electrophysiol

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“…A left atrial voltage map was created using the spiral catheter with a high resolution 3D mapping system (Carto-3, Biosense Webster). 500-1000 data points were [8,19,20]. The Carto-3 software was used to calculate the percentage of LVA of the left atrial surface.…”

Section: Acquisition Of Electroanatomical Voltage Mapsmentioning

confidence: 99%

TGFβ Is Specifically Upregulated on Circulating CD14++ CD16+ and CD14+ CD16++ Monocytes in Patients with Atrial Fibrillation and Severe Atrial Fibrosis

Heinzmann

Fuss

Ungern-Sternberg

et al. 2018

Cell Physiol Biochem

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Background/Aims: Fibrotic remodeling of the atria plays a key role in the pathogenesis of atrial fibrillation (AF). As little is known about the contribution of circulating monocytes in atrial remodeling and the pathophysiology of AF, we investigated profibrotic factors in different subsets of circulating monocytes obtained from patients with atrial fibrillation undergoing catheter ablation. Methods: A 3D high density voltage mapping was performed in sinus rhythm to evaluate the extent of low-voltage areas (LVAs) in the atria of 71 patients with persistent AF. Low-voltage was defined as signals of < 0.5mV during sinus rhythm. Prior to ablation, blood was drawn and monocytes were analyzed by FACS. Based on the expression of CD14 and CD16, three subgroups including CD14⁺⁺ CD16^- (‘classical’), CD14⁺⁺ CD16⁺ (‘intermediate’), and CD14⁺ CD16⁺⁺ (‘non-classical’) were analyzed for the expression of TGFb, CD147, and MMP-9, representing pivotal profibrotic pathways in myocardial remodeling. Results: Expression of TGFb was increased in CD14⁺ monocytes of patients with extensive LVAs compared to patients with a low extend of LVAs. While CD14⁺⁺ CD16^- monocytes showed no difference, CD14⁺⁺ CD16⁺ and CD14⁺ CD16⁺⁺ monocytes showed a strong increase of TGFb abundance. Although CD147 and MMP-9 are strongly associated with myocardial fibrosis, we found no difference in expression between the two groups in any monocyte subsets. Conclusion: TGFb is specifically upregulated on CD14⁺⁺ CD16⁺ and CD14⁺ CD16⁺⁺ monocytes in patients with extensive LVAs undergoing catheter ablation.

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Clinical scores used for the prediction of negative events in patients undergoing catheter ablation for atrial fibrillation

Kosich

Schumacher

Potpara³

et al. 2019

Clinical Cardiology

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Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia in adults. Catheter ablation (CA) is one of the most important management strategies to reduce AF burden and AF‐associated complications. In order to stratify the risk of adverse events and to predict treatment success in AF patients undergoing CA, several risk stratification scores had been developed during the last decade. The aim of this review is to provide an overview of the most important clinical risk scores predicting rhythm outcomes, electro‐anatomical substrate and mortality in AF.

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Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation

Cited by 91 publications

References 18 publications

Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information

Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information

TGFβ Is Specifically Upregulated on Circulating CD14++ CD16+ and CD14+ CD16++ Monocytes in Patients with Atrial Fibrillation and Severe Atrial Fibrosis

Clinical scores used for the prediction of negative events in patients undergoing catheter ablation for atrial fibrillation

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