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Atrial low voltage areas: A comparison between atrial fibrillation and sinus rhythm
, 3, 3, 2, 3, 2, 2, 1, 2
Affiliations- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Spain
- Unidad de Arritmias, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Universitat Politècnica de València, Spain
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Abstract
Background: Atrial fibrosis can promote atrial fibrillation (AF). Electroanatomic mapping (EAM) can provide information regarding local voltage abnormalities that may be used as a surrogate marker for fibrosis. Specific voltage cut-off values have been reproduced accurately to identify fibrosis in the ventricles, but these values are not well defined in atrial tissue.
Methods: This study is a prospective single-center study. Patients with persistent AF referred for ablation were included. EAM was performed before ablation. We recorded bipolar signals, first in AF and later in sinus rhythm (SR). Two thresholds delimited low-voltage areas (LVA), 0.5 and 0.3 mV. We compared LVA extension between maps in SR and AF in each patient.
Results: A total of 23 patients were included in the study. The percentage of points with voltage lower than 0.5 mV and 0.3 mV was significantly higher in maps in AF compared with maps in SR: 38.2% of points < 0.5 mV in AF vs. 22.9% in SR (p < 0.001); 22.3% of points < 0.3 mV in AF vs. 14% in SR (p < 0.001). Areas with reduced voltage were significantly larger in maps in AF (0.5 mV threshold, mean area in AF 41.3 ± 42.5 cm2 vs. 11.7 ± 17.9 cm2 in SR, p < 0.001; 0.3 mV threshold, mean area in AF 15.6 ± 22.1 cm2 vs. 6.2 ± 11.5 cm2 in SR, p < 0.001).
Conclusions: Using the same voltage thresholds, LVA extension in AF is greater than in SR in patients with persistent AF. These findings provide arguments for defining a different atrial fibrosis threshold based on EAM rhythm.
Abstract
Background: Atrial fibrosis can promote atrial fibrillation (AF). Electroanatomic mapping (EAM) can provide information regarding local voltage abnormalities that may be used as a surrogate marker for fibrosis. Specific voltage cut-off values have been reproduced accurately to identify fibrosis in the ventricles, but these values are not well defined in atrial tissue.
Methods: This study is a prospective single-center study. Patients with persistent AF referred for ablation were included. EAM was performed before ablation. We recorded bipolar signals, first in AF and later in sinus rhythm (SR). Two thresholds delimited low-voltage areas (LVA), 0.5 and 0.3 mV. We compared LVA extension between maps in SR and AF in each patient.
Results: A total of 23 patients were included in the study. The percentage of points with voltage lower than 0.5 mV and 0.3 mV was significantly higher in maps in AF compared with maps in SR: 38.2% of points < 0.5 mV in AF vs. 22.9% in SR (p < 0.001); 22.3% of points < 0.3 mV in AF vs. 14% in SR (p < 0.001). Areas with reduced voltage were significantly larger in maps in AF (0.5 mV threshold, mean area in AF 41.3 ± 42.5 cm2 vs. 11.7 ± 17.9 cm2 in SR, p < 0.001; 0.3 mV threshold, mean area in AF 15.6 ± 22.1 cm2 vs. 6.2 ± 11.5 cm2 in SR, p < 0.001).
Conclusions: Using the same voltage thresholds, LVA extension in AF is greater than in SR in patients with persistent AF. These findings provide arguments for defining a different atrial fibrosis threshold based on EAM rhythm.
Keywords
atrial fibrillation, electroanatomic mapping, low-voltage areas, atrial fibrosis threshold, pulmonary vein isolation
About this articleTitle
Atrial low voltage areas: A comparison between atrial fibrillation and sinus rhythm
Journal
Issue
Article type
Original Article
Pages
252-262
Published online
2021-10-08
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5908
Article views/downloads
926
DOI
10.5603/CJ.a2021.0125
Pubmed
Bibliographic record
Cardiol J 2022;29(2):252-262.
Keywords
atrial fibrillation
electroanatomic mapping
low-voltage areas
atrial fibrosis threshold
pulmonary vein isolation
Authors
Ana Andrés Lahuerta
Carlos Roberto
Francisco Javier Saiz
Óscar Cano
Laura Martínez-Mateu
Pau Alonso
Assumpció Saurí
Aurelio Quesada
Joaquín Osca
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