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Huang T, Chen J, Müller-Edenborn B, Mayer L, Eichenlaub M, Moreno Weidmann Z, Allgeier J, Bohnen M, Lehrmann H, Trenk D, Schoechlin S, Westermann D, Arentz T, Jadidi A. Validating left atrial fractionation and low-voltage substrate during atrial fibrillation and sinus rhythm-A high-density mapping study in persistent atrial fibrillation. Front Cardiovasc Med 2022; 9:1000027. [PMID: 36330001 PMCID: PMC9622778 DOI: 10.3389/fcvm.2022.1000027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/26/2022] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Low-voltage-substrate (LVS)-guided ablation for persistent atrial fibrillation (AF) has been described either in sinus rhythm (SR) or AF. Prolonged fractionated potentials (PFPs) may represent arrhythmogenic slow conduction substrate and potentially co-localize with LVS. We assess the spatial correlation of PFP identified in AF (PFP-AF) to those mapped in SR (PFP-SR). We further report the relationship between LVS and PFPs when mapped in AF or SR. MATERIALS AND METHODS Thirty-eight patients with ablation naïve persistent AF underwent left atrial (LA) high-density mapping in AF and SR prior to catheter ablation. Areas presenting PFP-AF and PFP-SR were annotated during mapping on the LA geometry. Low-voltage areas (LVA) were quantified using a bipolar threshold of 0.5 mV during both AF and SR mapping. Concordance of fractionated potentials (CFP) (defined as the presence of PFPs in both rhythms within a radius of 6 mm) was quantified. Spatial distribution and correlation of PFP and CFP with LVA were assessed. The predictors for CFP were determined. RESULTS PFPs displayed low voltages both during AF (median 0.30 mV (Q1-Q3: 0.20-0.50 mV) and SR (median 0.35 mV (Q1-Q3: 0.20-0.56 mV). The duration of PFP-SR was measured at 61 ms (Q1-Q3: 51-76 ms). During SR, most PFP-SRs (89.4 and 97.2%) were located within LVA (<0.5 mV and <1.0 mV, respectively). Areas presenting PFP occurred more frequently in AF than in SR (median: 9.5 vs. 8.0, p = 0.005). Both PFP-AF and PFP-SR were predominantly located at anterior LA (>40%), followed by posterior LA (>20%) and septal LA (>15%). The extent of LVA < 0.5 mV was more extensive in AF (median: 25.2% of LA surface, Q1-Q3:16.6-50.5%) than in SR (median: 12.3%, Q1-Q3: 4.7-29.4%, p = 0.001). CFP in both rhythms occurred in 80% of PFP-SR and 59% of PFP-AF (p = 0.008). Notably, CFP was positively correlated to the extent of LVA in SR (p = 0.004), but not with LVA in AF (p = 0.226). Additionally, the extent of LVA < 0.5 mV in SR was the only significant predictor for CFP, with an optimal threshold of 16% predicting high (>80%) fractionation concordance in AF and SR. CONCLUSION Substrate mapping in SR vs. AF reveals smaller areas of low voltage and fewer sites with PFP. PFP-SR are located within low-voltage areas in SR. There is a high degree of spatial agreement (80%) between PFP-AF and PFP-SR in patients with moderate LVA in SR (>16% of LA surface). These findings should be considered when substrate-based ablation strategies are applied in patients with the left atrial low-voltage substrate with recurrent persistent AF.
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Affiliation(s)
- Taiyuan Huang
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Juan Chen
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Björn Müller-Edenborn
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Louisa Mayer
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Martin Eichenlaub
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Zoraida Moreno Weidmann
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Juergen Allgeier
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marius Bohnen
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Heiko Lehrmann
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Dietmar Trenk
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Simon Schoechlin
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Dirk Westermann
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Arentz
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Amir Jadidi
- Department of Cardiology, Arrhythmia Division, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
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Saito D, Fukaya H, Oikawa J, Sato T, Matsuura G, Arakawa Y, Kobayashi S, Shirakawa Y, Ishizue N, Kishihara J, Niwano S, Ako J. Atrial late potentials are associated with atrial fibrillation recurrence after catheter ablation. J Arrhythm 2022; 38:991-996. [PMCID: PMC9745488 DOI: 10.1002/joa3.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Previous studies have identified noninvasive methods for predicting atrial fibrillation (AF) recurrence after catheter ablation (CA). We assessed the association between AF recurrence and atrial late potentials (ALPs), which were measured using P‐wave signal‐averaged electrocardiography (P‐SAECG). Methods Consecutive patients with paroxysmal AF who underwent their first CA at our institution between August 2015 and August 2019 were enrolled. P‐SAECG was performed before CA. Two ALP parameters were evaluated: the root‐mean‐square voltage during the terminal 20 ms (RMS20) and the P‐wave duration (PWD). Positive ALPs were defined as an RMS20 <2.2 μV and/or a PWD >115 ms. Patients were allocated to either the recurrence or nonrecurrence group based on the presence of AF recurrence at the 1‐year follow‐up post‐CA. Results Of the 190 patients (age: 65 ± 11 years, 37% women) enrolled in this study, 21 (11%) had AF recurrence. The positive ALP rate was significantly higher in the recurrence group than in the nonrecurrence group (86% vs. 64%, p = .04), despite the absence of differences in other baseline characteristics between the two groups. In the multivariate analysis, positive ALP was an independent predictor of AF recurrence (odds ratio: 3.83, 95% confidence interval: 1.05–14.1, p = .04). Conclusions Positive ALP on pre‐CA P‐SAECG is associated with AF recurrence after CA.
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Affiliation(s)
- Daiki Saito
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Hidehira Fukaya
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Jun Oikawa
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Tetsuro Sato
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Gen Matsuura
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Yuki Arakawa
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Shuhei Kobayashi
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Yuki Shirakawa
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Naruya Ishizue
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Jun Kishihara
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Shinichi Niwano
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
| | - Junya Ako
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaKanagawaJapan
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Budeus M, Hennersdorf M, Dierkes S, Preik M, Heintzen MP, Kelm M, Perings C. Effects of right coronary artery PTCA on variables of P-wave signal averaged electrocardiogram. Ann Noninvasive Electrocardiol 2003; 8:150-6. [PMID: 12848797 PMCID: PMC6932014 DOI: 10.1046/j.1542-474x.2003.08210.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND P-wave signal averaged ECG has been used to detect atrial late potentials that were found in paroxysmal atrial fibrillation. Ischemia is supposed to trigger ventricular late potentials, which indicate an elevated risk for ventricular tachycardia. Preexistent ventricular late potentials measured by ventricular signal averaged ECG is supposed to be eliminated by successful PTCA. METHODS We examined the incidence of atrial late potentials in patients with a proximal stenosis of the right coronary artery and new onset of atrial fibrillation. Furthermore, we investigated the anti-ischemic effect of a successful percutaneous transluminal coronary angioplasty.(PTCA) of the right coronary artery. P-wave signal averaged ECG from 23 patients who had a PTCA of the right coronary artery (group A) were compared to age, sex, and disease-matched control subjects (group B) one day before, one day after, and one month after PTCA. RESULTS A new appearance of paroxysmal atrial fibrillation was presented in eight patients before PTCA (group A1) of group A. Patients with a stenosis of the right coronary artery had a significantly higher incidence of supraventricular extrasystoles in a 24-hour-Holter ECG (131.1 +/- 45.4 vs 17.1 +/- 18.9, P < 0.0002). The duration of the filtered P wave was longer (124.8 +/- 11.9 vs 118.5 +/- 10.1 ms, P < 0.04) and the root mean square of the last 20 ms (RMS 20) was significantly lower in group A than in group B (2.87 +/- 1.09 vs 3.97 +/- 1.12 micro V, P < 0.01). A successful PTCA caused an increase in RMS 20 (2.87 +/- 1.11 vs 4.19 +/- 1.19 microV, P < 0.02) and a decrease in filtered P-wave duration (124.8 +/- 11.9 vs 118.4 +/- 10.4 ms, P < 0.04). Preexistent atrial late potentials were found among 15 patients before PTCA. After successful PTCA only 3 out of 15 patients were affected (P < 0.0004) after one day, as well as after one month. All patients with a history of atrial fibrillation did not suffer from an arrhythmic recurrence within the following six months after successful PTCA. CONCLUSION A stenosis of the right coronary artery is associated with atrial late potentials. A successful PTCA of the right coronary artery eliminates preexistent atrial late potentials and may reduce the risk of atrial fibrillation.
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Affiliation(s)
- Marco Budeus
- Department of Cardiology, Pneumology and Angiology, Medical Clinic and Policlinic B Heinrich-Heine-University, Duesseldorf, Germany.
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