Low voltage and low wave speed are rarely present outside the left atrium-pulmonary veins junction in paroxysmal atrial fibrillation but frequently present in persistent forms

Abstract

Abstract Background and aim Multielectrode high-density catheters have enabled acquisition of comprehensive and dense maps of electrogram’s amplitude and timing. However, automated activation and voltage mapping are flawed by catheter orientation in relation to the wavefront activation. Omnipolar mapping technology (OT) uses both unipolar and bipolar signals to obtain OT signals and increases the accuracy of automatic point acquisition allowing for a high- density map in a quick and efficient way. The aim of this study was to automatically assess with OT, the left atrium (LA) voltage and wave speed propagation map in sinus rhythm (SR) according to the type of atrial fibrillation (AF). Methods We studied 14 consecutive patients referred for ablation of AF, either paroxysmal (PAF) (n=6) or persistent (Pers-AF) (n=8) using catheters with OT. Patients with Pers-AF were cardioverted, and a SR map was obtained before ablation in all patients and voltage and propagation wave speed maps were obtained. The cut-off for low voltage areas (LVAs) was less than 0.1 mV and for low wave speed (LWS) was less than 0.4 mm/ms. Results were compared according to the type of AF. Results The results are depicted in the Table. The median duration of AF in Pers-AF was 18 (5-24) months. Patients with Pers-AF had larger LA volumes and displayed presence of LVAs and LWS areas in 100% of cases in comparison with 17% and 33% of cases respectively for PAF patients (p=0.003 and p=0.015). Also, the total LVAs and LWS areas in cm2 were significantly higher, (p=0.001 and p=0.005)). The LVAs and the LWS areas were more frequently located outside the PV-LA junction in Pers-AF than in PAF, respectively 75% vs 0% and 88% vs 0%, p=0.010 and p=0.005 (Figure). Conclusions Patients with PAF never presented LVAs or LWS outside the PV-LA junction. On the contrary, patients with Pers-AF had frequently anatomical and electrophysiological abnormalities in the LA body. These findings may suggest the need for a wider ablation strategy in Pers-AF.Normal voltage in purple ; LWS in white