Voltage during atrial fibrillation is superior to voltage during sinus rhythm in localizing areas of delayed enhancement on magnetic resonance imaging: An assessment of the posterior left atrium in patients with persistent atrial fibrillation.
Background: Bipolar electrogram voltage during sinus rhythm (VSR) has been used as a surrogate for atrial fibrosis in guiding catheter ablation of persistent atrial fibrillation (AF), but the fixed rate and wavefront characteristics present during sinus rhythm may not accurately reflect underlying f...
| Publicado en: | Heart Rhythm Vol. 16; no. 9; pp. 1357 - 1368 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Elsevier B.V.
Sep2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=138153313&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 138153313 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15475271 EHI jtl: Heart Rhythm issn: 15475271 maglogo: N pubinfo: dt: Sep2019 vid: 16 iid: 9 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 138153313 138153313 NLM31170484 138153313 10.1016/j.hrthm.2019.05.032 NLM31170484 138153313 ppf: 1357 ppct: 11 formats: tig: atl: Voltage during atrial fibrillation is superior to voltage during sinus rhythm in localizing areas of delayed enhancement on magnetic resonance imaging: An assessment of the posterior left atrium in patients with persistent atrial fibrillation. aug: au: Qureshi, Norman A. Kim, Steven J. Cantwell, Chris D. Afonso, Valtino X. Bai, Wenjia Ali, Rheeda L. Shun-Shin, Matt J. Malcolme-Lawes, Louisa C. Luther, Vishal Leong, Kevin M.W. Lim, Elaine Wright, Ian Nagy, Szabi Hayat, Sajad Ng, Fu Siong Wing, Michael Koa Linton, Nick W.F. Lefroy, David C. Whinnett, Zachary I. Davies, D. Wyn affil: Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom sug: subj: Atrial Fibrillation Etiology Atrial Fibrillation Surgery Heart Atrium Heart Atrium Physiopathology Atrial Fibrillation Physiopathology Atrial Fibrillation Diagnosis Magnetic Resonance Imaging Methods Heart Function Tests Methods Heart Atrium Pathology Fibrosis Complications Human Male Fibrosis Diagnosis Female Catheter Ablation Methods Middle Age Validation Studies Comparative Studies Evaluation Research Multicenter Studies Funding Source Middle Aged: 45-64 years Male Female ab: Background: Bipolar electrogram voltage during sinus rhythm (VSR) has been used as a surrogate for atrial fibrosis in guiding catheter ablation of persistent atrial fibrillation (AF), but the fixed rate and wavefront characteristics present during sinus rhythm may not accurately reflect underlying functional vulnerabilities responsible for AF maintenance.Objective: The purpose of this study was determine whether, given adequate temporal sampling, the spatial distribution of mean AF voltage (VmAF) better correlates with delayed-enhancement magnetic resonance imaging (MRI-DE)-detected atrial fibrosis than VSR.Methods: AF was mapped (8 seconds) during index ablation for persistent AF (20 patients) using a 20-pole catheter (660 ± 28 points/map). After cardioversion, VSR was mapped (557 ± 326 points/map). Electroanatomic and MRI-DE maps were co-registered in 14 patients.Results: The time course of VmAF was assessed from 1-40 AF cycles (∼8 seconds) at 1113 locations. VmAF stabilized with sampling >4 seconds (mean voltage error 0.05 mV). Paired point analysis of VmAF from segments acquired 30 seconds apart (3667 sites; 15 patients) showed strong correlation (r = 0.95; P <.001). Delayed enhancement (DE) was assessed across the posterior left atrial (LA) wall, occupying 33% ± 13%. VmAF distributions were (median [IQR]) 0.21 [0.14-0.35] mV in DE vs 0.52 [0.34-0.77] mV in non-DE regions. VSR distributions were 1.34 [0.65-2.48] mV in DE vs 2.37 [1.27-3.97] mV in non-DE. VmAF threshold of 0.35 mV yielded sensitivity of 75% and specificity of 79% in detecting MRI-DE compared with 63% and 67%, respectively, for VSR (1.8-mV threshold). CONCLUSION: The correlation between low-voltage and posterior LA MRI-DE is significantly improved when acquired during AF vs sinus rhythm. With adequate sampling, mean AF voltage is a reproducible marker reflecting the functional response to the underlying persistent AF substrate. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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