Introduction: Left atrial (LA) electroanatomical voltage mapping (EAVM) correlates with scar on LGE-MRI and has been used to guide ablation of low voltage area (LVA) in sinus rhythm (SR). We compared EAVM in SR and AF in a cohort of AF patients, and in SR between patients with AF and without AF or structural heart disease (control).
Methods and results: Twenty-seven AF patients, 9 with paroxysmal AF (PAF), underwent point-by-point EAVM during SR and AF using same Carto3 geometry. Only adjacent SR-AF points (≤ 5 mm apart) were compared. In addition, 6 control patients were evaluated. There was a linear bipolar voltage correlation between SR and AF (r = 0.707, P < 0.001, Y = 1.515X + 0.786). LA bipolar voltage in patients with PAF was higher than those with Non-PAF in SR (2.24 ± 1.51 vs. 1.56 ± 1.53 mV) and AF (0.81 ± 0.60 vs. 0.58 ± 0.62 mV, both for P < 0.001). The pulmonary vein antra voltage was significantly lower than other LA regions in PAF (1.28 ± 0.79 vs. 2.54 ± 1.50 mV, P < 0.001) and Non-PAF patients (1.13 ± 1.04 vs. 1.86 ± 1.72 mV, P < 0.001), while no voltage differences was found in the control group (P = 0.998).
Conclusion: There was a linear voltage correlation between SR and AF, suggesting a similar extent of LA fibrotic substrate can be identified on EAVM by adjusting the voltage cutoff. Structural remodeling starts in the PV antra and may progress to other LA regions.
Keywords: atrial fibrillation; atrial remodeling; catheter ablation; electroanatomical mapping; pulmonary vein.
© 2016 Wiley Periodicals, Inc.