Letter to the Editor: Catheter Ablation of Low Voltage Areas for Persistent Atrial Fibrillation: Procedural Outcomes using High-Density Voltage Mapping

2021 ◽  
Author(s):  
Pablo B. Nery ◽  
Girish M. Nair ◽  
David H. Birnie
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Low Voltage ◽  
Persistent Atrial Fibrillation ◽  
High Density ◽  
Letter To The Editor ◽  
Voltage Mapping ◽  
Procedural Outcomes

Catheter Ablation of Low-Voltage Areas for Persistent Atrial Fibrillation: Procedural Outcomes Using High-Density Voltage Mapping

2020 ◽  
Vol 36 (12) ◽  
pp. 1956-1964 ◽  
Author(s):  
Pablo B. Nery ◽  
Wael Alqarawi ◽  
Girish M. Nair ◽  
Mouhannad M. Sadek ◽  
Calum J. Redpath ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Low Voltage ◽  
Persistent Atrial Fibrillation ◽  
High Density ◽  
Voltage Mapping ◽  
Procedural Outcomes

scholarly journals Comparison of Unipolar and Bipolar Voltage Mapping for Localization of Left Atrial Arrhythmogenic Substrate in Patients With Atrial Fibrillation

2020 ◽  
Vol 11 ◽  
Author(s):  
Deborah Nairn ◽  
Heiko Lehrmann ◽  
Björn Müller-Edenborn ◽  
Steffen Schuler ◽  
Thomas Arentz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Low Voltage ◽  
High Density ◽  
Border Zone ◽  
Electrode Spacing ◽  
Bipolar Voltage ◽  
Voltage Mapping ◽  
Arrhythmogenic Substrate ◽  
The Impact

Background: Presence of left atrial low voltage substrate in bipolar voltage mapping is associated with increased arrhythmia recurrences following pulmonary vein isolation for atrial fibrillation (AF). Besides local myocardial fibrosis, bipolar voltage amplitudes may be influenced by inter-electrode spacing and bipole-to-wavefront-angle. It is unclear to what extent these impact low voltage areas (LVA) in the clinical setting. Alternatively, unipolar electrogram voltage is not affected by these factors but requires advanced filtering.Objectives: To assess the relationship between bipolar and unipolar voltage mapping in sinus rhythm (SR) and AF and identify if the electrogram recording mode affects the quantification and localization of LVA.Methods: Patients (n = 28, 66±7 years, 46% male, 82% persistent AF, 32% redo-procedures) underwent high-density (>1,200 sites, 20 ± 10 sites/cm2, using a 20-pole 2-6-2 mm-spaced Lasso) voltage mapping in SR and AF. Bipolar LVA were defined using four different thresholds described in literature: <0.5 and <1 mV in SR, <0.35 and <0.5 mV in AF. The optimal unipolar voltage threshold resulting in the highest agreement in both unipolar and bipolar mapping modes was determined. The impact of the inter-electrode distance (2 vs. 6 mm) on the correlation was assessed. Regional analysis was performed using an 11-segment left atrial model.Results: Patients had relevant bipolar LVA (23 ± 23 cm2 at <0.5 mV in SR and 42 ± 26 cm2 at <0.5 mV in AF). 90 ± 5% (in SR) and 85 ± 5% (AF) of mapped sites were concordantly classified as high or low voltage in both mapping modes. Discordant mapping sites located to the border zone of LVA. Bipolar voltage mapping using 2 vs. 6 mm inter-electrode distances increased the portion of matched mapping points by 4%. The unipolar thresholds (y) which resulted in a high spatial concordance can be calculated from the bipolar threshold (x) using following linear equations: y = 1.06x + 0.26mV (r = 0.994) for SR and y = 1.22x + 0.12mV (r = 0.998) for AF.Conclusion: Bipolar and unipolar voltage maps are highly correlated, in SR and AF. While bipole orientation and inter-electrode spacing are theoretical confounders, their impact is unlikely to be of clinical importance for localization of LVA, when mapping is performed at high density with a 20-polar Lasso catheter.

scholarly journals Ablation of persistent atrial fibrillation based on high density voltage mapping and complex fractionated atrial electrograms

Medicine ◽  
2021 ◽  
Vol 100 (31) ◽  
pp. e26702
Author(s):  
Jongmin Hwang ◽  
Hyoung-Seob Park ◽  
Seongwook Han ◽  
Cheol Hyun Lee ◽  
In-Cheol Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
High Density ◽  
Voltage Mapping ◽  
Atrial Electrograms ◽  
Complex Fractionated Atrial Electrograms
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