Quantitative assessment of left atrial scar using high-density voltage mapping and a novel automated voltage analysis tool

Herczeg, Szilvia; Walsh, Katie; Keaney, John F.; Keelan, Edward; Travers, John; Galvin, Joseph

doi:10.1007/s10840-019-00570-7

Cited by 11 publications

(27 citation statements)

References 19 publications

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“…e VHA tool has proven useful in rapid determination of LA scar burden, which has shown good correlation to known AF risk factors [10].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with nonvalvular symptomatic, antiarrhythmic drug-refractory paroxysmal or persistent atrial fibrillation who underwent a pulmonary vein isolation (PVI) procedure at the Mater Private Hospital, Dublin, in 2017 were consecutively included in a prospective, single-centre observational study. The results of the LA VHA and its relation to the AF risk factors have been previously published [ 10 ]. In the present study, we have included a subset of the patients from the original cohort where additional right atrial mapping was also performed.…”

Section: Methodsmentioning

confidence: 99%

“…We focused on determining the relationship between the baseline characteristics and the median percentage of the diseased RA tissue burden. Patients with a Next, we determined whether or not the RA parameters would relate to the diseased LA tissue burden where the diseased tissue was defined as a bipolar voltage of ≤0.5 mV in accordance with our previous publication [10]. Patients were divided into 2 subgroups according to their percentage of the LA diseased tissue: patients with the highest burden (in the upper quartile of the diseased LA tissue, LA-Q4) formed one group and those in the lower quartiles (LA-Q1-3) formed the other.…”

Section: Biatrial Mapping and Voltage Analysismentioning

confidence: 99%

“…Recently, we have described that voltage histogram analysis (VHA), a novel tool used in electroanatomical mapping, was able to assess the burden of LA LVA [10].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, we have described that voltage histogram analysis (VHA), a novel tool used in electroanatomical mapping, was able to assess the burden of LA LVA [ 10 ]. There is growing evidence suggesting that more severe LA fibrosis is detected in the elderly and in AF patients with comorbidities such as hypertension, heart failure, diabetes, or obesity [ 3 , 9 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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The Value of Voltage Histogram Analysis Derived Right Atrial Scar Burden in the Prediction of Left Atrial Scar Burden

Herczeg

Galvin

Keaney

et al. 2020

Cardiology Research and Practice

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Introduction. Growing evidence suggests that fibrotic changes can be observed in atrial fibrillation (AF) in both atria. Quantification of the scar burden during electroanatomical mapping might have important therapeutic and prognostic consequences. However, as the current invasive treatment of AF is focused on the left atrium (LA), the role of the right atrium (RA) is less well understood. We aimed to characterize the clinical determinates of the RA low-voltage burden and its relation to the LA scaring. Methods. We have included 36 patients who underwent catheter ablation for AF in a prospective observational study. In addition to LA mapping and ablation, high-density RA bipolar voltage maps (HD-EAM) were also reconstructed. The extent of the diseased RA tissue (≤0.5 mV) was quantified using the voltage histogram analysis tool (CARTO®3, Biosense Webster). Results. The percentage of RA diseased tissue burden was significantly higher in patients with a CHA2DS2-VASc score ≥ 2 p=0.0305, higher indexed LA volume on the CTA scan and on the HD‐EAM (p=0.0223 and p=0.0064, respectively), or higher indexed RA volume on the HD‐EAM p=0.0026. High RA diseased tissue burden predicted the presence of high LA diseased tissue burden (OR = 7.1, CI (95%): 1.3–38.9, p=0.0145), and there was a significant correlation of the same (r = 0.6461, p<0.0001). Conclusions. Determining the extent of the right atrial low-voltage burden might give useful clinical information. According to our results, the diseased tissue burden correlates well between the two atria: the right atrium mirrors the left atrium.

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“…e VHA tool has proven useful in rapid determination of LA scar burden, which has shown good correlation to known AF risk factors [10].…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Biatrial Mapping and Voltage Analysismentioning

confidence: 99%

“…Recently, we have described that voltage histogram analysis (VHA), a novel tool used in electroanatomical mapping, was able to assess the burden of LA LVA [10].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Value of Voltage Histogram Analysis Derived Right Atrial Scar Burden in the Prediction of Left Atrial Scar Burden

Herczeg

Galvin

Keaney

et al. 2020

Cardiology Research and Practice

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Left atrial scar identification and quantification in sinus rhythm and atrial fibrillation

Mannion¹,

Galvin²,

Boles³

2020

Journal of Arrhythmia

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Identification and quantification of low voltage areas (LVA) in atrial fibrillation (AF), identified by their bipolar voltages (BiV) via electro‐anatomical voltage mapping is an area of interest to prognosis of AF free burden. LVAs have been linked to diseased left atrial (LA) tissue which results in pro‐fibrillatory potentials. These LVAs are dominantly found within the pulmonary veins, however, as the disease progresses other areas of the LA show low voltage. The scar burden of the LA is linked to recurrence of the arrhythmia and can be a target of further modification. This burden is classically assessed once sinus rhythm (SR) is attained, but this is susceptible to operator variability with overestimated dense LA scar (<0.2 mV) and underestimated diseased LA tissue (<0.5 mV). The novel automated voltage histogram analysis (VHA) tool may increase accuracy, however, is yet to be fully validated. A recent study indicates that LVAs can be assessed just as reliably in AF as SR, but BiV is lower with linear correlation to SR values (0.24‐0.5 mV respectively). In this paper, we review current data as well as review current methods of identifying, quantifying, and grading LA scar. We also compared AF vs SR voltages of a patient undergoing catheter ablation in our site using our VHA tool to compare the results. In keeping with the cited papers, we found lower voltages in our patient measured in AF. This area warrants further study to assess correlation in more patients, with view to developing prognostic and therapeutic grading systems.

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The Role of Imaging Techniques in Electrophysiologic Procedures

Faletra

Regoli

Leo

et al. 2021

Practical 3D Echocardiography

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Quantitative assessment of left atrial scar using high-density voltage mapping and a novel automated voltage analysis tool

Cited by 11 publications

References 19 publications

The Value of Voltage Histogram Analysis Derived Right Atrial Scar Burden in the Prediction of Left Atrial Scar Burden

The Value of Voltage Histogram Analysis Derived Right Atrial Scar Burden in the Prediction of Left Atrial Scar Burden

Left atrial scar identification and quantification in sinus rhythm and atrial fibrillation

The Role of Imaging Techniques in Electrophysiologic Procedures

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