Left Atrial Electroanatomical Voltage Mapping to Characterize Substrate and Guide Ablation
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(2020) 22:33
Arrhythmia (R Kabra, Section Editor)
Left Atrial Electroanatomical Voltage Mapping to Characterize Substrate and Guide Ablation Bishnu P. Dhakal, MD1 Mathew D. Hutchinson, MD, FACC, FHRS2,* Address 1 Cardiology Division, Sarver Heart Center, University of Arizona, Tucson, AZ, USA *,2 Cardiac Electrophysiology Program, Sarver Heart Center, University of Arizona College of Medicine – Tucson, 1501 N. Campbell Avenue, 4142B, Tucson, AZ, 85724, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Arrhythmia Keywords Atrial fibrillation I Atrial fibrosis I Electroanatomical mapping I Catheter ablation
Abstract Purpose of Review Despite enthusiasm for catheter ablation of atrial fibrillation, procedural outcomes are less robust when compared to other atrial arrhythmias Recent Findings Adverse atrial remodeling is associated with both the perpetuation of atrial fibrillation as well as decreased responsiveness to restorative therapies. However, characterization of remodeling has historically relied on demographic factors and echocardiographic imaging which provide inadequate insight into the pattern and distribution of atrial fibrosis. Advancements in electroanatomical mapping allow rapid collection of dense threedimensional maps that display both structural and functional datasets. Summary The purpose of this review is to discuss contemporary studies that seek to determine bipolar electrogram characteristics in patients with and without atrial fibrillation. We will also review studies that use electrogram data to guide substrate-based ablation in AF patients.
Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting up to 1% of the general population. The prevalence of AF in the USA was 2.7 to 6.1 million in 2010 with
an estimated increase in prevalence to 12.1 million in 2030 [1, 2]. AF is associated with an increased risk of ischemic stroke and an age-adjusted mortality rate of 6.5 per 100,000 people [1].
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Curr Treat Options Cardio Med
The management of symptomatic AF with antiarrhythmic medications is limited by both their relative inefficacy and their significant adverse effects [2–4]. In patients in whom antiarrhythmic agents are either ineffective or poorly tolerated, catheter ablation is a suitable alternative [3]. Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation ablation, and good clinical outcomes have been demonstrated in patients with paroxysmal AF using this strategy alone [5]. There can be non-pulmonary vein (PV) triggers in patients with AF [6]. The recognition that AF burden reduction is a meaningful clinical outcome in ablation patients has rightly broadened the traditional binary definition of procedural success [7]. Ablation outcomes in patients with persistent and long-standing persistent AF, however, have been less robust [8]. The relative importance of AF initiation (i.e., triggers) versus
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