Unipolar voltage electroanatomic mapping detects structural atrial remodeling identified by LGE-MRI

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Understanding the left atrial (LA) substrate is critical for atrial fibrillation (AF) management.
• Electroanatomic mapping (EAM) and late gadolinium enhancement magnetic resonance imaging (LGE-MRI) assess atrial substrate and predict ablation outcomes.
• Discrepancies exist between EAM-defined low-voltage areas (LVAs) and LGE regions.

Purpose of the Study:

• To explore the relationship between LGE regions and unipolar and bipolar LVAs.
• To investigate the utility of multipolar high-density mapping in characterizing the atrial substrate.

Main Methods:

• Twenty patients undergoing AF ablation had preablation LGE-MRI.
• Deep learning segmented LA and created a 3D mesh integrating LGE data.
• High-density EAM was performed, and maps were coregistered with LGE-MRI data.

Main Results:

• Unipolar LVAs demonstrated an 87.3% overlap with LGE regions, significantly higher than the 16.2% overlap with bipolar LVAs.
• Unipolar LVAs showed superior performance across all metrics (precision, sensitivity, F1 score, accuracy) in identifying LGE areas compared to bipolar LVAs.
• Specific performance metrics: Unipolar (Precision: 78.6%, Sensitivity: 87.3%, F1: 81.3%, Accuracy: 74.0%) vs. Bipolar (Precision: 61.1%, Sensitivity: 16.2%, F1: 26.0%, Accuracy: 35.3%).

Conclusions:

• Unipolar LVAs strongly correlate with LGE regions, indicating their value in substrate characterization.
• Integrating unipolar mapping with bipolar mapping in clinical practice offers a more nuanced approach to AF diagnosis and management.
• This integrated approach provides critical insights into the atrial substrate's complex architecture for improved patient care.