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Updated: May 7, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
The impact of atrial voltage and conduction velocity phenotypes on atrial fibrillation recurrence
Pedro Silva Cunha1,2,3,4,5, Sérgio Laranjo1,2,5,6, Sofia Monteiro1,3,7
1Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Lisbon, Portugal.
Insights
Slow atrial conduction velocity (CV) predicts atrial fibrillation (AF) recurrence better than low atrial voltage. Identifying distinct patient phenotypes is key for personalized AF management strategies.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Low atrial voltage and slow conduction velocity (CV) are linked to atrial fibrillation (AF).
- The interaction and early disease marker potential of these factors are not fully understood.
Purpose of the Study:
- To investigate the relationship between atrial voltage and CV in patients with AF.
- To identify distinct patient phenotypes using high-density electroanatomic (HDE) mapping.
Main Methods:
- Analysis of HDE maps during sinus rhythm in 52 AF patients and 5 controls.
- Generation of atrial voltage and CV maps, followed by correlation and subgroup analyses.
- Cluster analysis to define phenotypes based on conduction and voltage patterns.
Main Results:
- Moderate positive correlation found between mean atrial voltage and CV (r=0.570).
- Three distinct phenotypes identified: normal voltage/normal CV, normal voltage/low CV, and low voltage/low CV.
- Slower atrial CV significantly predicted AF recurrence post-ablation, outperforming atrial voltage prediction.
Conclusions:
- Atrial voltage and CV analyses reveal distinct AF patient phenotypes.
- Lower atrial CV is a stronger predictor of AF recurrence than atrial voltage.
- Findings highlight the importance of CV and voltage in AF management and personalized treatment strategies.
Introduction:
Low atrial voltage and slow conduction velocity (CV) have been associated with atrial fibrillation (AF); however, their interaction and relative importance as early disease markers remain incompletely understood. We aimed to elucidate the relationship between atrial voltage and CV using high-density electroanatomic (HDE) maps of patients with AF.
Methods:
HDE maps obtained during sinus rhythm in 52 patients with AF and five healthy controls were analysed. Atrial voltage and CV maps were generated, and their correlations were assessed. Subgroup analyses were performed based on clinically relevant factors such as AF type, CV, and voltage levels. Finally, cluster analysis was conducted to identify distinct phenotypes within the population, reflecting different patterns of conduction and voltage.
Results:
A moderate positive correlation was found between the mean atrial voltage and CV (r = 0.570). Subgroup analysis revealed differences in voltage (p = 0.0044) but not in global CV (p = 0.42), with no significant differences between AF types. Three distinct phenotypes emerged: normal voltage/normal CV, normal voltage/low CV, and low voltage/low CV, with distinct recurrence rates, suggesting different disease progression paths. Slower atrial CV was identified as a significant predictor of arrhythmia recurrence at 12 and 24 months after AF ablation, surpassing the predictive potential of atrial voltage.
Conclusion:
Atrial voltage and CV analyses revealed distinct phenotypes. Lower atrial CV emerged as a significant predictor of AF recurrence, exceeding the predictive significance of atrial voltage. These findings emphasise the importance of considering CV and voltage in managing AF and offer potential insights for personalised strategies.
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