Moisés Rodríguez-Mañero1, Miguel Valderrábano2, Aurora Baluja3, Omar Kreidieh4, Jose Luis Martínez-Sande5, Javier García-Seara5, Johan Saenen6, Diego Iglesias-Álvarez5, Wim Bories6, Luis Miguel Villamayor-Blanco7, María Pereira-Vázquez7, Ricardo Lage5, Julián Álvarez-Escudero3, Hein Heidbuchel6, José Ramón González-Juanatey5, Andrea Sarkozy6. 1. Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226 - CB16/11/00420), Madrid, Spain. Electronic address: moirmanero@gmail.com. 2. Division of Cardiac Electrophysiology, Department of Cardiology Houston Methodist Hospital, Houston, Texas. 3. Critical Patient Translational Research Group, Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínico Universitario, Santiago de Compostela, Spain. 4. Cardiology Department, Newark Beth Israel Medical Center, Newark, New Jersey. 5. Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226 - CB16/11/00420), Madrid, Spain. 6. Cardiology Department, Cardiac Electrophysiology Section, University Hospital of Antwerp, Antwerp, Belgium. 7. Cardiology Department, Hospital Universitario Santiago de Compostela, Santiago de Compostela, IDIS, Spain.
Abstract
OBJECTIVES: This study aimed: 1) to determine the voltage correlation between sinus rhythm (SR) and atrial fibrillation (AF)/atrial flutter (AFL) using multielectrode fast automated mapping; 2) to identify a bipolar voltage cutoff for scar and/or low voltage areas (LVAs); and 3) to examine the reproducibility of voltage mapping in AF. BACKGROUND: It is unclear if bipolar voltage cutoffs should be adjusted depending on the rhythm and/or area being mapped. METHODS: High-density mapping was performed first in SR and afterward in induced AF/AFL. In some patients, 2 maps were performed during AF. Maps were combined to create a new one. Points of <1 mm difference were analyzed. Correlation was explored with scatterplots and agreement analysis was assessed with Bland-Altman plots. The generalized additive model was also applied. RESULTS: A total of 2,002 paired-points were obtained. A cutoff of 0.35 mV in AFL predicted a sinus voltage of 0.5 mV (95% confidence interval [CI]: 0.12 to 2.02) and of 0.24 mV in AF (95% CI: 0.11 to 2.18; specificity [SP]: 0.94 and 0.96; sensitivity [SE]: 0.85 and 0.75, respectively). When generalized additive models were used, a cutoff of 0.38 mV was used for AFL for predicting a minimum value of 0.5 mV in SR (95% CI: 0.5 to 1.6; SP: 0.94, SE: 0.88) and of 0.31 mV for AF (95% CI: 0.5 to 1.2; SP: 0.95, SE: 0.82). With regard to AF maps, there was no change in the classification of any left atrial region other than the roof. CONCLUSIONS: It is possible to establish new cutoffs for AFL and/or AF with acceptable validity in predicting a sinus voltage of <0.5 mV. Multielectrode fast automated mapping in AFL and/or AF seems to be reliable and reproducible when classifying LVAs. These observations have clinical implications for left atrial voltage distribution and in procedures in which scar distribution is used to guide pulmonary vein isolation and/or re-isolation.
OBJECTIVES: This study aimed: 1) to determine the voltage correlation between sinus rhythm (SR) and atrial fibrillation (AF)/atrial flutter (AFL) using multielectrode fast automated mapping; 2) to identify a bipolar voltage cutoff for scar and/or low voltage areas (LVAs); and 3) to examine the reproducibility of voltage mapping in AF. BACKGROUND: It is unclear if bipolar voltage cutoffs should be adjusted depending on the rhythm and/or area being mapped. METHODS: High-density mapping was performed first in SR and afterward in induced AF/AFL. In some patients, 2 maps were performed during AF. Maps were combined to create a new one. Points of <1 mm difference were analyzed. Correlation was explored with scatterplots and agreement analysis was assessed with Bland-Altman plots. The generalized additive model was also applied. RESULTS: A total of 2,002 paired-points were obtained. A cutoff of 0.35 mV in AFL predicted a sinus voltage of 0.5 mV (95% confidence interval [CI]: 0.12 to 2.02) and of 0.24 mV in AF (95% CI: 0.11 to 2.18; specificity [SP]: 0.94 and 0.96; sensitivity [SE]: 0.85 and 0.75, respectively). When generalized additive models were used, a cutoff of 0.38 mV was used for AFL for predicting a minimum value of 0.5 mV in SR (95% CI: 0.5 to 1.6; SP: 0.94, SE: 0.88) and of 0.31 mV for AF (95% CI: 0.5 to 1.2; SP: 0.95, SE: 0.82). With regard to AF maps, there was no change in the classification of any left atrial region other than the roof. CONCLUSIONS: It is possible to establish new cutoffs for AFL and/or AF with acceptable validity in predicting a sinus voltage of <0.5 mV. Multielectrode fast automated mapping in AFL and/or AF seems to be reliable and reproducible when classifying LVAs. These observations have clinical implications for left atrial voltage distribution and in procedures in which scar distribution is used to guide pulmonary vein isolation and/or re-isolation.
Authors: Mark Nothstein; Armin Luik; Amir Jadidi; Jorge Sánchez; Laura A Unger; Eike M Wülfers; Olaf Dössel; Gunnar Seemann; Claus Schmitt; Axel Loewe Journal: Front Physiol Date: 2021-05-24 Impact factor: 4.566
Authors: Deborah Nairn; Heiko Lehrmann; Björn Müller-Edenborn; Steffen Schuler; Thomas Arentz; Olaf Dössel; Amir Jadidi; Axel Loewe Journal: Front Physiol Date: 2020-11-26 Impact factor: 4.566
Authors: Iwanari Kawamura; Petr Neuzil; Poojita Shivamurthy; Kenji Kuroki; Jeff Lam; Daniel Musikantow; Edward Chu; Mohit K Turagam; Kentro Minami; Moritoshi Funasako; Jan Petru; Subbarao Choudry; Marc A Miller; Marie-Noelle Langan; William Whang; Srinivas R Dukkipati; Jacob S Koruth; Vivek Y Reddy Journal: Europace Date: 2021-11-08 Impact factor: 5.214