Sinus rhythm voltage fingerprinting in patients with mitral valve disease using a high-density epicardial mapping approach

Schie, Mathijs S. van; Starreveld, Roeliene; Bogers, Ad J.J.C.; Groot, Natasja M.S. de

doi:10.1093/europace/euaa336

Cited by 21 publications

(10 citation statements)

References 30 publications

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“…In the present study, we did not correlate low-voltage areas with CV, as it remains very challenging to identify a correct threshold to define low-voltage areas. Additionally, prior high-resolution epicardial mapping studies demonstrated no clear relationship between CV and low voltage areas [14,39]. In our study population, in general we have found lower voltages at BB in patients with AF compared to patients without AF.…”

Section: Low Voltages and Atrial Fibrillationcontrasting

confidence: 49%

Reduction of Conduction Velocity in Patients with Atrial Fibrillation

Heida

Schie

Does

et al. 2021

JCM

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It is unknown to what extent atrial fibrillation (AF) episodes affect intra-atrial conduction velocity (CV) and whether regional differences in local CV heterogeneities exist during sinus rhythm. This case-control study aims to compare CV assessed throughout both atria between patients with and without AF. Patients (n = 34) underwent intra-operative epicardial mapping of the right atrium (RA), Bachmann’s bundle (BB), left atrium (LA) and pulmonary vein area (PVA). CV vectors were constructed to calculate median CV in addition to total activation times (TAT) and unipolar voltages. Biatrial median CV did not differ between patients with and without AF (90 ± 8 cm/s vs. 92 ± 6 cm/s, p = 0.56); only BB showed a CV reduction in the AF group (79 ± 12 cm/s vs. 88 ± 11 cm/s, p = 0.02). In patients without AF, there was no predilection site for the lowest CV (P5) (RA: 12%; BB: 29%; LA: 29%; PVA: 29%). In patients with AF, lowest CV was most often measured at BB (53%) and ranged between 15 to 22 cm/s (median: 20 cm/s). Lowest CVs were also measured at the LA (18%) and PVA (29%), but not at the RA. AF was associated with a prolonged TAT (p = 0.03) and decreased voltages (P5) at BB (p = 0.02). BB was a predilection site for slowing of conduction in patients with AF. Prolonged TAT and decreased voltages were also found at this site. The next step will be to determine the relevance of a reduced CV at BB in relation to AF development and maintenance.

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Section: Low Voltages and Atrial Fibrillationcontrasting

confidence: 49%

Reduction of Conduction Velocity in Patients with Atrial Fibrillation

Heida

Schie

Does

et al. 2021

JCM

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“…Van Schie et al have demonstrated that unipolar voltage is lower in areas of slowed conduction or CB, or areas containing fractionated potentials, which might indicate areas of arrhythmogenic tissue. 70 In this study, unipolar LVAs were found in all 67 patients with MVD with and without a history of paroxysmal AF, although lower voltages and more LVAs were found at BB in paroxysmal AF patients. There were no predilection sites for low voltages to occur.…”

Section: Unipolar Voltage Mappingmentioning

confidence: 48%

“…In the late 1990s, Konings et al described a classification of U-EGMs based on the number of negative deflections, which is easy to measure, especially during SR. 75 Van Schie et al have demonstrated that MVD patients with paroxysmal AF had more unipolar fractionated potentials at the PV area compared to those without a history of AF. 70 However, fractionation can also be a consequence of variation in the anatomy of the atrial wall and therefore functional anisotropy. U-EGM and Bi-EGM fractionation has also been linked to asynchronous activation of the endo-and epicardium, which may be a significant mechanism for the persistence of AF.…”

Section: Use Of Electrogram Morphology and Fractionationmentioning

confidence: 99%

Clinical Relevance of Sinus Rhythm Mapping to Quantify Electropathology Related to Atrial Fibrillation

Schie

Groot

2022

Arrhythm Electrophysiol Rev

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Progression of AF is accompanied by structural and electrical remodelling, resulting in complex electrical conduction disorders. This is defined as electropathology and it increases with the progression of AF. The severity of electropathology, thus, defines the stage of AF and is a major determinant of effectiveness of AF therapy. As specific features of AF-related electropathology are still unknown, it is essential to first quantify the electrophysiological properties of atrial tissue and then to examine the inter- and intra-individual variation during normal sinus rhythm. Comparison of these parameters between patients with and without a history of AF unravels quantified electrophysiological features that are specific to AF patients. This can help to identify patients at risk for early onset or progression of AF. This review summarises current knowledge on quantified features of atrial electrophysiological properties during sinus rhythm and discusses its relevance in identifying AF-related electropathology.

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“… 26 Although unipolar electrograms are not affected by directional sensitivity, substrate assessment by solely unipolar voltage is also limited. 36 We found that even in omnipolar LVAs there are still high unipolar voltages and a large variety of CVs. The logarithmic relationship between RA CV and bipolar voltage found by Itoh et al 30 also shows that for a relatively narrow interval of bipolar voltages a broad spectrum of CVs can be found.…”

Section: Discussionmentioning

confidence: 67%

Identification of Low-Voltage Areas: A Unipolar, Bipolar, and Omnipolar Perspective

Schie¹,

Kharbanda²,

Houck³

et al. 2021

Circ: Arrhythmia and Electrophysiology

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Background - Low-voltage areas (LVA) are commonly considered surrogate markers for an arrhythmogenic substrate underlying tachyarrhythmias. It remains challenging to define a proper threshold to classify LVA and it is unknown whether unipolar, bipolar and the recently introduced omnipolar voltage mapping techniques are complementary or contradictory in classifying LVAs. Therefore, this study examined similarities and dissimilarities in unipolar, bipolar and omnipolar voltage mapping and explored the relation between various types of voltages and conduction velocity (CV). Methods - Intra-operative epicardial mapping (interelectrode distance 2mm, ±1900 sites) was performed during sinus rhythm in 21 patients (48±13 years, 9 male) with atrial volume overload. Cliques of 4 electrodes (2x2 mm) were used to calculate the maximal unipolar (V uni,max ), bipolar (V bi,max ) and omnipolar (V omni,max ) voltages and mean CV. Areas with V bi,max or V omni,max ≤0.5 mV were defined as LVA. Results - V uni,max was not only larger than V bi,max but also larger than V omni,max (7.08 [4.22-10.59] mV vs. 5.27 [2.39-9.56] mV and 5.77 [2.58-10.52] mV respectively, P<0.001). In addition, the largest bipolar clique voltage was on average 1.66 (range: 1.0 - 59.0) times larger to the corresponding perpendicular bipolar voltage pair. LVAs identified by a bipolar or omnipolar threshold corresponded to a broad spectrum of unipolar voltages and, even though CV was generally decreased, still high CVs and large unipolar voltages were found in these LVAs. Conclusions - In patients with atrial volume overload, there were considerable discrepancies in the different types of LVAs. Additionally, identification of LVAs was hampered by considerable directional differences in bipolar voltages. Even using directional independent omnipolar voltage to identify LVAs, high CVs and large unipolar voltages are present within these areas. Therefore, a combination of low unipolar and low omnipolar voltage may be more indicative of 'true' LVAs.

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Sinus rhythm voltage fingerprinting in patients with mitral valve disease using a high-density epicardial mapping approach

Cited by 21 publications

References 30 publications

Reduction of Conduction Velocity in Patients with Atrial Fibrillation

Reduction of Conduction Velocity in Patients with Atrial Fibrillation

Clinical Relevance of Sinus Rhythm Mapping to Quantify Electropathology Related to Atrial Fibrillation

Identification of Low-Voltage Areas: A Unipolar, Bipolar, and Omnipolar Perspective

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