Gabriel Ballesteros1, Susana Ravassa2,3,4, Jean Bragard5, Pablo Ramos1, Begoña López2,3,4, Enrique Vives1, Renzo Neglia1, Bernardo Wise1, Arantxa González2,3,4, María U Moreno2,3,4, Javier Díez1,2,3,4,6, Ignacio García-Bolao1. 1. Department of Cardiology and Cardiac Surgery, Clínica Universidad de Navarra, Pamplona, Spain. 2. Program of Cardiovascular Diseases, Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain. 3. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. 4. CIBERCV, Carlos III Institute of Health, Madrid, Spain. 5. Department of Physics and Applied Math, Universidad de Navarra, Pamplona, Spain. 6. Department of Nephrology, Clínica Universidad de Navarra, Pamplona, Spain.
Abstract
INTRODUCTION: Ultrahigh-density-voltage mapping (uHDV M) is a new tool that can add new insights into the pathophysiology of atrial fibrillation (AF). The aim of this study was to evaluate the performance of uHDV M in predicting postablation AF recurrence (AFR). METHODS AND RESULTS: We included 98 consecutive patients undergoing pulmonary vein isolation for AF (40.8% persistent) using an uHDV M system and followed for 1 year. The left atrium (LA) mean voltage (Vm ) and the Vslope (slope of the voltage histogram calculated by linear interpolation, with the relative frequency on the vertical axis and the bipolar potential on the horizontal axis) were calculated from 12 567 ± 5486 points per map. Patients with AFR (N = 29) had lower Vm and higher Vslope as compared with patients without AFR (N = 69). Receiver operating characteristic curves identified Vm as the strongest predictor of AFR, with a higher incidence of AFR in patients with Vm 0.758 mV (57.6%) or lower than patients with Vm higher than 0.758 mV (15.4%; P < .0001). Among patients with Vm higher than 0.758 mV, patients with Vslope 0.637 or higher exhibited higher (P = .043) AFR incidence (31.3%) than patients with Vslope lower than 0.637 (10.2%). This classification showed incremental predictive value over relevant covariables. Vm values were lower and Vslope values were higher in patients that progressed from paroxysmal to persistent AF. Patients with Vslope 0.637 or higher had a 14.2% incidence of postablation atypical atrial flutter, whereas patients with Vslope lower than 0.637 did not present this outcome. CONCLUSIONS: The risk of AFR, atrial flutter, and progression from paroxysmal to persistent AF can be detected by quantitative analysis of LA uHDV M identifying diverse patterns of atrial substrate alterations.
INTRODUCTION: Ultrahigh-density-voltage mapping (uHDV M) is a new tool that can add new insights into the pathophysiology of atrial fibrillation (AF). The aim of this study was to evaluate the performance of uHDV M in predicting postablation AF recurrence (AFR). METHODS AND RESULTS: We included 98 consecutive patients undergoing pulmonary vein isolation for AF (40.8% persistent) using an uHDV M system and followed for 1 year. The left atrium (LA) mean voltage (Vm ) and the Vslope (slope of the voltage histogram calculated by linear interpolation, with the relative frequency on the vertical axis and the bipolar potential on the horizontal axis) were calculated from 12 567 ± 5486 points per map. Patients with AFR (N = 29) had lower Vm and higher Vslope as compared with patients without AFR (N = 69). Receiver operating characteristic curves identified Vm as the strongest predictor of AFR, with a higher incidence of AFR in patients with Vm 0.758 mV (57.6%) or lower than patients with Vm higher than 0.758 mV (15.4%; P < .0001). Among patients with Vm higher than 0.758 mV, patients with Vslope 0.637 or higher exhibited higher (P = .043) AFR incidence (31.3%) than patients with Vslope lower than 0.637 (10.2%). This classification showed incremental predictive value over relevant covariables. Vm values were lower and Vslope values were higher in patients that progressed from paroxysmal to persistent AF. Patients with Vslope 0.637 or higher had a 14.2% incidence of postablation atypical atrial flutter, whereas patients with Vslope lower than 0.637 did not present this outcome. CONCLUSIONS: The risk of AFR, atrial flutter, and progression from paroxysmal to persistent AF can be detected by quantitative analysis of LA uHDV M identifying diverse patterns of atrial substrate alterations.
Authors: Valentina A Rossi; Iva Krizanovic-Grgic; Jan Steffel; Daniel Hofer; Thomas Wolber; Corinna B Brunckhorst; Frank Ruschitzka; Firat Duru; Alexander Breitenstein; Ardan M Saguner Journal: Cardiol J Date: 2022-03-14 Impact factor: 3.487