Validating left atrial fractionation and low-voltage substrate during atrial fibrillation and sinus rhythm-A high-density mapping study in persistent atrial fibrillation
Huang, Taiyuan (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Chen, Juan (Medical School of Nanjing University)
Müller-Edenborn, Björn (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Mayer, Louisa (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Eichenlaub, Martin (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Moreno Weidmann, Zoraida (Institut d'Investigació Biomèdica Sant Pau)
Allgeier, Juergen (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Bohnen, Marius (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Lehrmann, Heiko (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Trenk, Dietmar (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Schoechlin, Simon (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Westermann, Dirk (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Arentz, Thomas (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))
Jadidi, Amir (Universitäts-Herzzentrum Bad Krozingen (Freiburg, Alemanya))

Date:	2022
Abstract:	Background: Low-voltage-substrate (LVS)-guided ablation for persistent atrial fibrillation (AF) has been described either in sinus rhythm (SR) or AF. Prolonged fractionated potentials (PFPs) may represent arrhythmogenic slow conduction substrate and potentially co-localize with LVS. We assess the spatial correlation of PFP identified in AF (PFP-AF) to those mapped in SR (PFP-SR). We further report the relationship between LVS and PFPs when mapped in AF or SR. Materials and methods: Thirty-eight patients with ablation naïve persistent AF underwent left atrial (LA) high-density mapping in AF and SR prior to catheter ablation. Areas presenting PFP-AF and PFP-SR were annotated during mapping on the LA geometry. Low-voltage areas (LVA) were quantified using a bipolar threshold of 0. 5 mV during both AF and SR mapping. Concordance of fractionated potentials (CFP) (defined as the presence of PFPs in both rhythms within a radius of 6 mm) was quantified. Spatial distribution and correlation of PFP and CFP with LVA were assessed. The predictors for CFP were determined. Results: PFPs displayed low voltages both during AF (median 0. 30 mV (Q1-Q3: 0. 20-0. 50 mV) and SR (median 0. 35 mV (Q1-Q3: 0. 20-0. 56 mV). The duration of PFP-SR was measured at 61 ms (Q1-Q3: 51-76 ms). During SR, most PFP-SRs (89. 4 and 97. 2%) were located within LVA (<0. 5 mV and <1. 0 mV, respectively). Areas presenting PFP occurred more frequently in AF than in SR (median: 9. 5 vs. 8. 0, p = 0. 005). Both PFP-AF and PFP-SR were predominantly located at anterior LA (>40%), followed by posterior LA (>20%) and septal LA (>15%). The extent of LVA < 0. 5 mV was more extensive in AF (median: 25. 2% of LA surface, Q1-Q3:16. 6-50. 5%) than in SR (median: 12. 3%, Q1-Q3: 4. 7-29. 4%, p = 0. 001). CFP in both rhythms occurred in 80% of PFP-SR and 59% of PFP-AF (p = 0. 008). Notably, CFP was positively correlated to the extent of LVA in SR (p = 0. 004), but not with LVA in AF (p = 0. 226). Additionally, the extent of LVA < 0. 5 mV in SR was the only significant predictor for CFP, with an optimal threshold of 16% predicting high (>80%) fractionation concordance in AF and SR. Conclusion: Substrate mapping in SR vs. AF reveals smaller areas of low voltage and fewer sites with PFP. PFP-SR are located within low-voltage areas in SR. There is a high degree of spatial agreement (80%) between PFP-AF and PFP-SR in patients with moderate LVA in SR (>16% of LA surface). These findings should be considered when substrate-based ablation strategies are applied in patients with the left atrial low-voltage substrate with recurrent persistent AF.
Note:	Altres ajuts: Deutsche Herzstiftung (German Heart Foundation).
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Persistent atrial fibrillation ; Mapping ; Catheter ablation ; Prolonged fractionated potential ; Pulmonary vein isolation ; Atrial late potentials ; Low voltage ; Substrate
Published in:	Frontiers in Cardiovascular Medicine, Vol. 9 (October 2022) , p. 1000027, ISSN 2297-055X

DOI: 10.3389/fcvm.2022.1000027
PMID: 36330001

12 p, 2.7 MB

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