Contact electroanatomic mapping derived voltage criteria for characterizing left atrial scar in patients undergoing ablation for atrial fibrillation

Suraj Kapa, Benoit Desjardins, David J. Callans, Francis E. Marchlinski, Sanjay Dixit

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Voltage Criteria for Left Atrial Scar Background Criteria have not been established for identifying LA scar using electroanatomic mapping (EAM). It is also unclear if voltage criteria using EAM may assist in identifying areas of pulmonary vein (PV) reconnection in patients undergoing repeat AF ablation. Objectives To characterize left atrial (LA) voltage in patients undergoing atrial fibrillation (AF) ablation. Methods An LA shell was created and bipolar voltage amplitude (in mV) at each point was measured. The shell was divided into 8 regions. Bipolar voltage values lower than the amplitude of 95% of sampled points was used as the upper cutoff value. Delayed enhancement (DE) cardiac magnetic resonance imaging (CMRI) sequences were performed to validate voltage cutoffs. Results Twenty patients participated. A mean of 141 ± 12 points constituted the LA map that was created during sinus rhythm (SR). In patients undergoing initial AF ablation, mean bipolar LA voltage was 1.44 ± 1.27 mV. In patients undergoing repeat AF ablation, scar along the posterior wall and LA-PV junction was identified using a voltage cutoff <0.2 mV, whereas a cutoff <0.45 mV best identified scar at other locations. This voltage range (0.2-0.45 mV) was useful to identify areas of reconnection around the PVs. On DE CMRI, a bipolar voltage cutoff of 0.27 mV performed best for delineating scar (sensitivity: 90%, specificity: 83%). Conclusions In patients undergoing AF ablation, EAM derived LA bipolar voltage shows regional variation. For maps acquired during SR, a voltage range of 0.2-0.45 mV can accurately demarcate LA scar distribution. This can be helpful in identifying PV reconnection in patients undergoing repeat AF ablation.

Original languageEnglish (US)
Pages (from-to)1044-1052
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number10
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Atrial Fibrillation
Cicatrix
Pulmonary Veins
Magnetic Resonance Imaging
Sensitivity and Specificity

Keywords

  • ablation
  • atrial fibrillation
  • atrial scar
  • cardiac magnetic resonance imaging
  • catheter ablation
  • electroanatomic mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Contact electroanatomic mapping derived voltage criteria for characterizing left atrial scar in patients undergoing ablation for atrial fibrillation. / Kapa, Suraj; Desjardins, Benoit; Callans, David J.; Marchlinski, Francis E.; Dixit, Sanjay.

In: Journal of Cardiovascular Electrophysiology, Vol. 25, No. 10, 01.01.2014, p. 1044-1052.

Research output: Contribution to journalArticle

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title = "Contact electroanatomic mapping derived voltage criteria for characterizing left atrial scar in patients undergoing ablation for atrial fibrillation",
abstract = "Voltage Criteria for Left Atrial Scar Background Criteria have not been established for identifying LA scar using electroanatomic mapping (EAM). It is also unclear if voltage criteria using EAM may assist in identifying areas of pulmonary vein (PV) reconnection in patients undergoing repeat AF ablation. Objectives To characterize left atrial (LA) voltage in patients undergoing atrial fibrillation (AF) ablation. Methods An LA shell was created and bipolar voltage amplitude (in mV) at each point was measured. The shell was divided into 8 regions. Bipolar voltage values lower than the amplitude of 95{\%} of sampled points was used as the upper cutoff value. Delayed enhancement (DE) cardiac magnetic resonance imaging (CMRI) sequences were performed to validate voltage cutoffs. Results Twenty patients participated. A mean of 141 ± 12 points constituted the LA map that was created during sinus rhythm (SR). In patients undergoing initial AF ablation, mean bipolar LA voltage was 1.44 ± 1.27 mV. In patients undergoing repeat AF ablation, scar along the posterior wall and LA-PV junction was identified using a voltage cutoff <0.2 mV, whereas a cutoff <0.45 mV best identified scar at other locations. This voltage range (0.2-0.45 mV) was useful to identify areas of reconnection around the PVs. On DE CMRI, a bipolar voltage cutoff of 0.27 mV performed best for delineating scar (sensitivity: 90{\%}, specificity: 83{\%}). Conclusions In patients undergoing AF ablation, EAM derived LA bipolar voltage shows regional variation. For maps acquired during SR, a voltage range of 0.2-0.45 mV can accurately demarcate LA scar distribution. This can be helpful in identifying PV reconnection in patients undergoing repeat AF ablation.",
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N2 - Voltage Criteria for Left Atrial Scar Background Criteria have not been established for identifying LA scar using electroanatomic mapping (EAM). It is also unclear if voltage criteria using EAM may assist in identifying areas of pulmonary vein (PV) reconnection in patients undergoing repeat AF ablation. Objectives To characterize left atrial (LA) voltage in patients undergoing atrial fibrillation (AF) ablation. Methods An LA shell was created and bipolar voltage amplitude (in mV) at each point was measured. The shell was divided into 8 regions. Bipolar voltage values lower than the amplitude of 95% of sampled points was used as the upper cutoff value. Delayed enhancement (DE) cardiac magnetic resonance imaging (CMRI) sequences were performed to validate voltage cutoffs. Results Twenty patients participated. A mean of 141 ± 12 points constituted the LA map that was created during sinus rhythm (SR). In patients undergoing initial AF ablation, mean bipolar LA voltage was 1.44 ± 1.27 mV. In patients undergoing repeat AF ablation, scar along the posterior wall and LA-PV junction was identified using a voltage cutoff <0.2 mV, whereas a cutoff <0.45 mV best identified scar at other locations. This voltage range (0.2-0.45 mV) was useful to identify areas of reconnection around the PVs. On DE CMRI, a bipolar voltage cutoff of 0.27 mV performed best for delineating scar (sensitivity: 90%, specificity: 83%). Conclusions In patients undergoing AF ablation, EAM derived LA bipolar voltage shows regional variation. For maps acquired during SR, a voltage range of 0.2-0.45 mV can accurately demarcate LA scar distribution. This can be helpful in identifying PV reconnection in patients undergoing repeat AF ablation.

AB - Voltage Criteria for Left Atrial Scar Background Criteria have not been established for identifying LA scar using electroanatomic mapping (EAM). It is also unclear if voltage criteria using EAM may assist in identifying areas of pulmonary vein (PV) reconnection in patients undergoing repeat AF ablation. Objectives To characterize left atrial (LA) voltage in patients undergoing atrial fibrillation (AF) ablation. Methods An LA shell was created and bipolar voltage amplitude (in mV) at each point was measured. The shell was divided into 8 regions. Bipolar voltage values lower than the amplitude of 95% of sampled points was used as the upper cutoff value. Delayed enhancement (DE) cardiac magnetic resonance imaging (CMRI) sequences were performed to validate voltage cutoffs. Results Twenty patients participated. A mean of 141 ± 12 points constituted the LA map that was created during sinus rhythm (SR). In patients undergoing initial AF ablation, mean bipolar LA voltage was 1.44 ± 1.27 mV. In patients undergoing repeat AF ablation, scar along the posterior wall and LA-PV junction was identified using a voltage cutoff <0.2 mV, whereas a cutoff <0.45 mV best identified scar at other locations. This voltage range (0.2-0.45 mV) was useful to identify areas of reconnection around the PVs. On DE CMRI, a bipolar voltage cutoff of 0.27 mV performed best for delineating scar (sensitivity: 90%, specificity: 83%). Conclusions In patients undergoing AF ablation, EAM derived LA bipolar voltage shows regional variation. For maps acquired during SR, a voltage range of 0.2-0.45 mV can accurately demarcate LA scar distribution. This can be helpful in identifying PV reconnection in patients undergoing repeat AF ablation.

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