Quantitative assessment of left atrial scar using high-density voltage mapping and a novel automated voltage analysis to

  • PDF / 626,775 Bytes
  • 8 Pages / 595.276 x 790.866 pts Page_size
  • 8 Downloads / 164 Views

DOWNLOAD

REPORT


Quantitative assessment of left atrial scar using high-density voltage mapping and a novel automated voltage analysis tool Szilvia Herczeg 1 & Katie Walsh 2 & John J Keaney 2 & Edward Keelan 2 & John Travers 2 & Gabor Szeplaki 2 & Joseph Galvin 2 Received: 27 January 2019 / Accepted: 19 May 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract Purpose Left atrial (LA) fibrosis plays an important role in the pathogenesis and perpetuation of atrial fibrillation (AF). It may be identified by bipolar voltage (BiV) mapping, but quantification of fibrosis which previously relied on visual estimation of scar has been shown to be inaccurate. Our aim was to use a novel automated voltage histogram analysis (VHA) tool to quantify LA scar burden accurately in patients with AF. Methods LA voltage was assessed in 100 consecutive patients undergoing first pulmonary vein isolation (PVI) for paroxysmal or persistent AF using a circular multielectrode catheter to create high-density LA BiV maps which were analysed using the VHA tool after the procedure. Results High-density electro-anatomic maps took 10 min to create and contained a median of 1049 points. The VHA algorithm accurately quantified the burden of Diseased LA Tissue (≤ 0.5 mV) and Dense LA Scar (≤ 0.2 mV) with a median of 17.8% and 3.5% respectively. A quartile classification was applied based on diseased LA tissue burden. Patients in class IV with the highest diseased LA burden were older (p < 0.0001), more likely female (p = 0.0095), had higher CHA2DS2-VASc scores (p = 0.0024) and were more likely to have persistent rather than paroxysmal AF (p = 0.0179) than those in classes I–III. Conclusions The VHA algorithm is able to quantify percentage surface area voltage rapidly and according to preset ranges for the first time. The algorithm offers the potential for classification of patients undergoing AF ablation into different classes of diseased LA burden, which may have diagnostic, therapeutic and prognostic implications. Keywords Atrial fibrillation . Pulmonary vein isolation . Voltage mapping . Scar . Fibrosis . Electroanatomical mapping

1 Introduction The role of left atrial (LA) fibrosis or scar is well recognised in the pathogenesis and perpetuation of atrial fibrillation (AF) [1]. LA fibrosis has been associated with an increased tendency to develop AF and progress from paroxysmal to persistent AF and increases recurrence rates after AF ablation. Substrateguided strategies targeting these areas for ablation as an adjunct to pulmonary vein isolation (PVI) have been employed [2, 3]. LA fibrosis in vivo can be identified non-invasively using delayed enhancement cardiac magnetic resonance imaging (DE-MRI) protocols or invasively using LA bipolar voltage (BiV) mapping [4, 5].

However, fibrosis assessment has been fraught with difficulties due to the complexity and limited availability of DEMRI protocols and lack of consistency of BiV sampling techniques and measurement. No single technique of LA scar assessment has been widely adopted. Few