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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

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Title: 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
Authors: Qureshi, N
Kim, S
Cantwell, C
Afonso, V
Bai, WJ
Ali, R
Shun-Shin, M
Louisa, M-L
Luther, V
Leong, K
Lim, E
Wright, I
Nagy, S
Hayat, S
Ng, FS
Koa-Wing, M
Linton, N
Lefroy, D
Whinnett, Z
Davies, DW
Kanagaratnam, P
Peters, N
Lim, PB
Item Type: Journal Article
Abstract: Background Bipolar electrogram voltage during sinus rhythm (VSR) has been used as a surrogate for atrial fibrosis in guiding catheter ablation of persistent AF, but the fixed rate and wavefront characteristics present during sinus rhythm may not accurately reflect underlying functional vulnerabilities responsible for AF maintenance. Objectives We hypothesized that given adequate temporal sampling, the spatial distribution of mean AF voltage (VmAF) should better correlate with delayed-enhancement MRI (MRI-DE) detected atrial fibrosis than VSR. Methods AF was mapped (8s) during index ablation for persistent AF (20 patients) using a 20-pole catheter (660±28 points/map). Following cardioversion, VSR was mapped (557±326 points/map). Electroanatomic and MRI-DE maps were co-registered in 14 patients. Results (i) The time course of VmAF was assessed from 1-40 AF-cycles (∼8s) at 1113 locations. VmAF stabilized with sampling >4s (mean voltage error=0.05mV). (ii) Paired point analysis of VmAF from segments acquired 30s apart (3,667-sites, 15-patients), showed strong correlation (r=0.95, p<0.001). (iii) Delayed-enhancement (DE) was assessed across the posterior left atrial (LA) wall, occupying 33±13%. VmAF distributions (median[IQR]) were 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. A VmAF threshold of 0.35mV yielded sensitivity/specificity 75%/79% in detecting MRI-DE, compared with 63%/67% for VSR (1.8mV 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.
Issue Date: Sep-2019
Date of Acceptance: 25-May-2019
URI: http://hdl.handle.net/10044/1/70699
DOI: 10.1016/j.hrthm.2019.05.032
ISSN: 1547-5271
Publisher: Elsevier
Start Page: 1357
End Page: 1367
Journal / Book Title: Heart Rhythm
Volume: 16
Issue: 9
Copyright Statement: © 2019 The Authors. Published by Elsevier Inc. on behalf of Heart Rhythm Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Sponsor/Funder: British Heart Foundation
British Heart Foundation
British Heart Foundation
British Heart Foundation
Rosetrees Trust
Rosetrees Trust
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
British Heart Foundation
British Heart Foundation
Wellcome Trust
Hansen Medical, Inc
St Jude Medical UK Ltd
Medical Research Council (MRC)
British Heart Foundation
Funder's Grant Number: RG/10/11/28457
FS/14/46/30907
PG/16/17/32069
PG/16/17/32069
A1173/ M577
A1407/ M645
RDB02
RDB02
RDF01
RE/18/4/34215
RG/16/3/32175
097816/Z/11/B
N/A
WHCP_P41917
MC_PC_12015
FS/15/25/31423
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Atrial fibrillation
Atrial fibrosis
Atrial fibrillation voltage
Magnetic resonance imaging
CATHETER ABLATION
FIBROSIS
MRI
QUANTIFICATION
ASSOCIATION
TACHYCARDIA
INTEGRATION
LESIONS
ROTORS
SCAR
Atrial fibrillation
Atrial fibrillation voltage
Atrial fibrosis
Magnetic resonance imaging
1102 Cardiorespiratory Medicine and Haematology
0903 Biomedical Engineering
Cardiovascular System & Hematology
Publication Status: Published
Online Publication Date: 2019-06-03
Appears in Collections:Faculty of Engineering
Bioengineering
National Heart and Lung Institute
Aeronautics
Faculty of Medicine



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