Regional left atrial voltage in patients with atrial fibrillation

Marcus, Gregory M.; Yang, Yanfei; Varosy, Paul D.; Ordovás, Karen; Tseng, Zian H.; Badhwar, Nitish; Lee, Byron K.; Lee, Randall J.; Scheinman, Melvin M.; Olgin, Jeffrey E.

doi:10.1016/j.hrthm.2006.10.017

Cited by 76 publications

(84 citation statements)

References 19 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is also consistent with previous reports, which suggest a regional distribution of structural defects in AF patients-most often affecting the LAPW and septum. 5,11,13 In ≈90% of our patients, voltage maps demonstrated reproducibility of LVAs. Previously undetected LVAs may indicate disease progression in the LVA group, whereas new LVAs were not detected in previously healthy atria.…”

Section: Lvas and Structural Substrate In The Atriummentioning

confidence: 55%

See 1 more Smart Citation

Tailored Atrial Substrate Modification Based on Low-Voltage Areas in Catheter Ablation of Atrial Fibrillation

Rolf

Kircher

Arya

et al. 2014

Circ: Arrhythmia and Electrophysiology

460

511

View full text Add to dashboard Cite

Background-Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a novel individualized approach for catheter ablation of atrial fibrillation (AF) based on low-voltage areas (LVAs) in the left atrium (LA). We sought to assess (1) the incidence of LVAs in patients undergoing AF catheter ablation, (2) the distribution of LVAs within the LA, and (3) the effect of an individualized ablation strategy on long-term rhythm outcomes. Methods and Results-In 178 patients with paroxysmal or persistent AF, LA voltage maps were created during sinus rhythm after circumferential pulmonary vein isolation. Subsequent substrate modification was confined to the presence of LVA (<0.5 mV) and inducible regular atrial tachycardias. LVAs were identified in 35% and 10% of patients with persistent and paroxysmal AF, respectively. The LA roof and the anterior, septal, and posterior wall LA were most often affected. The 12-month atrial tachycardias/AF-free survival was 62% for patients without LVAs and 70% for patients with LVAs and tailored substrate modification (P=0.3). Success rate in a comparison group of 26 LVA patients without further substrate modification was 27%. Conclusions-LVAs can be found at preferred sites in 10% of patients with paroxysmal AF and in 35% of patients with persistent AF. This is the first clinical report describing a consistent voltage-based approach for substrate modification in addition to circumferential pulmonary vein isolation irrespective of AF type. Application of this limited individualized approach may have the potential to compensate for the impaired 12-month outcome of patients with endocardial structural defects. (Circ Arrhythm Electrophysiol. 2014;7:825-833.)

show abstract

Section: Lvas and Structural Substrate In The Atriummentioning

confidence: 55%

“…11 Oakes et al 5 have shown that LA fibrosis and scar tissue detected by delayed enhancement cardiac MRI correlate well with LVAs on voltage maps. We found significant LVAs within the LA in 47 patients (27% overall and 35% in patients with persistent AF).…”

Section: Lvas and Structural Substrate In The Atriummentioning

confidence: 96%

Tailored Atrial Substrate Modification Based on Low-Voltage Areas in Catheter Ablation of Atrial Fibrillation

Rolf

Kircher

Arya

et al. 2014

Circ: Arrhythmia and Electrophysiology

460

511

View full text Add to dashboard Cite

show abstract

“…Recent studies have shown that, in comparison to conventional PVI, PVI with the addition of voltage-guided substrate modification achieved by targeting the lowvoltage area is more effective, is safer, and leads to lower proarrhythmic potential [9][10][11][12][13] . A measurement of < 0.5 mV was used in several previous studies as the criterion for identifying low-voltage areas indicative of interstitial fibrosis in the right and left atria [14][15][16] in the setting of SR or atrial pacing. Furthermore, both Malcolme-Lawes et al and Oaks et al showed that LA voltage < 0.5mV during SR corresponds to LA fibrosis identified by delayed enhancement magnetic resonance imaging (MRI) 17,18) .…”

Section: La Voltages During Sr and Afmentioning

confidence: 99%

“…Pre-existent left atrial (LA) scars indicated by low-voltage zones (LVZs) on 3-dimensional (3D) electroanatomic maps are implicated in suboptimum ablation outcomes 7,8) , and success has been achieved in patients with PerAF when, in addition to PVI, the atrial substrate has been modified by ablation of low-voltage areas detected during sinus rhythm (SR) [9][10][11][12][13] . Slight differences exist between the definitions of such low-voltage zones (LVZs), which are described variously as areas of bipolar voltage of < 0.4 mV ~ < 0.5 mV, depending on the group of investigators [14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Predicting Left Atrial Low-Voltage Areas During Sinus Rhythm on the Basis of Low Voltage During Atrial Fibrillation

Takahashi

Watanabe

Okumura

et al. 2018

Nichidai Igaku Zasshi

View full text Add to dashboard Cite

Background: As we have found a significant correlation between left atrial (LA) voltage during sinus rhythm (SR) and that during atrial fibrillation (AF), we hypothesized that the existence of low-voltage zones (LVZs) during AF can be used to identify LVZs during SR. Therefore, we conducted a study to test this hypothesis.Methods: In 8 patients, high-density bipolar voltage mapping (> 300 points) of the left atrium was performed with a 20-pole circular catheter with 4-4-4-mm interelectrode spacing. The left atrium was divided into 7 segments, and the mean LA bipolar voltages recorded over 5 seconds during SR and AF were determined by measurement of the peak-to-peak amplitudes.Results: LVZs identified at each segment were compared between SR and AF. LA bipolar voltages obtained during SR and AF correlated positively (r = 0.74, p < 0.0001). With the low voltage during SR defined as < 0.5 mV, the low voltage of < 0.2 mV during AF approximately matched the low LVZs mapped during SR.Conclusions: These findings indicate that LVZs of < 0.5 mV during SR could be predicted from LVZs identified during AF by designating a threshold AF voltage of 0.2 mV.

show abstract

“…Potentials with amplitudes >0.5 mV were defined as normal and coded in purple color, and potentials <0.2 mV as low voltage coded in red or gray. 30,31 In low voltage areas highdensity mapping was performed to delineate them from the high voltage areas. The interpolation was adjusted to 15 in both NavX and Carto cases.…”

Section: Catheter Ablation Proceduresmentioning

confidence: 99%

Impact of Metabolic Syndrome on Left Atrial Electroanatomical Remodeling and Outcomes After Radiofrequency Ablation of Nonvalvular Atrial Fibrillation

Dinov

Kosiuk

Kircher

et al. 2014

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

Regional left atrial voltage in patients with atrial fibrillation

Abstract: BACKGROUND-Regional differences in fibrosis, particularly related to the posterior wall and septum, may be important in atrial fibrillation (AF). Using electroanatomic mapping, voltage can be used as a measure of fibrosis.

Cited by 76 publications

References 19 publications

Tailored Atrial Substrate Modification Based on Low-Voltage Areas in Catheter Ablation of Atrial Fibrillation

Tailored Atrial Substrate Modification Based on Low-Voltage Areas in Catheter Ablation of Atrial Fibrillation

Predicting Left Atrial Low-Voltage Areas During Sinus Rhythm on the Basis of Low Voltage During Atrial Fibrillation

Impact of Metabolic Syndrome on Left Atrial Electroanatomical Remodeling and Outcomes After Radiofrequency Ablation of Nonvalvular Atrial Fibrillation

Contact Info

Product

Resources

About