Comparing Left Atrial Low Voltage Areas in Sinus Rhythm and Atrial Fibrillation Using Novel Automated Voltage...

Area of Science:

• Electrophysiology
• Cardiac Anatomy
• Medical Imaging

Background:

• Low voltage areas (LVAs) are proposed surrogates for left atrial (LA) scar.
• Previous studies correlated sinus rhythm (SR) and atrial fibrillation (AF) voltages using point-by-point analysis.
• High-density automated voltage histogram analysis (VHA) offers a novel approach for LA voltage assessment.

Purpose of the Study:

• To compare LA voltage composition in SR versus AF using VHA.
• To evaluate the impact of mapping rhythm on LVA characterization in patients with persistent AF (PeAF) undergoing pulmonary vein isolation (PVI).

Main Methods:

• Retrospective analysis of 10 patients with PeAF undergoing PVI.
• High-density LA voltage mapping performed in both AF and SR post-PVI.
• Voltage Histogram Analysis (VHA) applied to six anatomical segments, categorizing LVAs into 0-0.5 mV aliquots.

Main Results:

• Diseased LA tissue (0.21-0.5 mV) burden was significantly higher in AF compared to SR, particularly in anterior, roof, lateral, and posterior segments.
• Severe LVAs (≤0.2 mV) burden showed good correlation and comparability between AF and SR, with an exception noted on the posterior wall.
• Mapping rhythm demonstrated a differential effect on LA voltage ranges, impacting diseased tissue more than severe LVAs.

Conclusions:

• Mapping rhythm significantly influences the assessment of diseased LA tissue (0.21-0.5 mV), with higher burdens observed during AF.
• Severe LA scar (≤0.2 mV) appears relatively consistent between AF and SR, except in the posterior wall.
• These findings highlight the importance of considering the mapping rhythm when interpreting LA voltage maps, especially for diseased tissue characterization.