Progressive Remodeling of the Atrial Substrate—A Novel Finding from Consecutive Voltage Mapping in Patients with Recurrence of Atrial Fibrillation After Catheter Ablation

Abstract

Atrial substrate remodeling with a progressive decrease in the left atrial voltage was demonstrated in patients with recurrent AF.

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…167 It has been a powerful research tool that has enhanced our understanding of the atrial substrate in patients with paroxysmal and persistent atrial fibrillation and 74,434 those who have failed initial PV antrum isolation. 435 Unlike cardiac MR, CT, or echocardiography, EAM requires invasive catheterization and mapping. However, despite recent advances in MRI techniques that allow for imaging atrial scar, EAM imaging arguably has a great clinical feasibility and superior ability to image and to define the atrial substrate that leads to the development of atrial fibrillation.…”

Associations Between Renal Function, Atrial Substrate Properties and Outcome of Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation

“…The details have been described previously. [15][16][17][18] In brief, after completing the RA and LA geometry, a sequential contact voltage map was constructed in all patients during sinus rhythm. For the patients with an AF occurrence during the procedure, external direct current cardioversion was performed to convert the patients to sinus rhythm before mapping was performed.…”

Three-Dimensional Electroanatomic Mapping Systems in Catheter Ablation of Atrial Fibrillation

“…14 Much evidence for identifying the substrate properties has been provided by both contact and noncontact mapping systems. [13][14][15][16][17][18][19][20][21][22] Using the contact mapping system, it was reported by Sanders et al that slowing of atrial regional conduction with a greater number of electrograms with fractionation and areas of low voltage occurred in patients with congestive heart failure and sinus node disease. 14, 16 Verma et al reported that the preexistence of a LA scar in patients undergoing PV isolation was a powerful, independent predictor of a procedural failure.…”

“…Lo et al also found progressive remodeling of the atrial substrate in patients with recurrent AF (Figure 1). 18 Using a noncontact mapping system, Lin et al demonstrated that the substrate properties of activation and cycle-length-dependent voltage reduction may be related to the development of atrial flutter and AF. 19 Higa et al also beautifully delineated the preferential conduction of focal atrial tachycardia from a small area in the atrium, reporting that two-thirds of the atrial tachycardias originated from low-voltage zones, or border zones near the low-voltage zone, and could safely be eliminated by radiofrequency ablation.…”

“…Moreover, there are extensive low-voltage zones and scars in these AF patients, which may cause difficulty in capturing the atrium during entrainment. 13,[17][18][19] The 3D electroanatomic mapping systems provide an effective alternative to mapping and localizing post-ablation atrial tachycardias. Using the 3D mapping system, Chang et al found that post-ablation reentrant atrial tachycardia had a greater incidence of gaps in the LA appendage ridge, whereas focal atrial tachycardia had a higher incidence of gaps in the PV carina.…”