Kapa Suraj, Desjardins Benoit, Callans David J, Marchlinski Francis E, Dixit Sanjay
Division of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Cardiovasc Electrophysiol. 2014 Oct;25(10):1044-52. doi: 10.1111/jce.12452. Epub 2014 Jun 11.
Criteria have not been established for identifying LA scar using electroanatomic mapping (EAM). It is also unclear if voltage criteria using EAM may assist in identifying areas of pulmonary vein (PV) reconnection in patients undergoing repeat AF ablation.
To characterize left atrial (LA) voltage in patients undergoing atrial fibrillation (AF) ablation.
An LA shell was created and bipolar voltage amplitude (in mV) at each point was measured. The shell was divided into 8 regions. Bipolar voltage values lower than the amplitude of 95% of sampled points was used as the upper cutoff value. Delayed enhancement (DE) cardiac magnetic resonance imaging (CMRI) sequences were performed to validate voltage cutoffs.
Twenty patients participated. A mean of 141 ± 12 points constituted the LA map that was created during sinus rhythm (SR). In patients undergoing initial AF ablation, mean bipolar LA voltage was 1.44 ± 1.27 mV. In patients undergoing repeat AF ablation, scar along the posterior wall and LA-PV junction was identified using a voltage cutoff <0.2 mV, whereas a cutoff <0.45 mV best identified scar at other locations. This voltage range (0.2-0.45 mV) was useful to identify areas of reconnection around the PVs. On DE CMRI, a bipolar voltage cutoff of 0.27 mV performed best for delineating scar (sensitivity: 90%, specificity: 83%).
In patients undergoing AF ablation, EAM derived LA bipolar voltage shows regional variation. For maps acquired during SR, a voltage range of 0.2-0.45 mV can accurately demarcate LA scar distribution. This can be helpful in identifying PV reconnection in patients undergoing repeat AF ablation.
尚未建立使用电解剖标测（EAM）识别左心房（LA）瘢痕的标准。使用EAM的电压标准是否有助于识别接受再次房颤消融患者的肺静脉（PV）重新连接区域也尚不清楚。
描述接受房颤（AF）消融患者的左心房（LA）电压特征。
创建一个LA外壳，并测量每个点的双极电压幅度（以mV为单位）。将外壳分为8个区域。低于95%采样点幅度的双极电压值用作上限值。进行延迟强化（DE）心脏磁共振成像（CMRI）序列以验证电压截止值。
20名患者参与。窦性心律（SR）期间创建的LA图平均由141±12个点组成。在接受初次房颤消融的患者中，LA平均双极电压为1.44±1.27 mV。在接受再次房颤消融的患者中，使用<0.2 mV的电压截止值可识别后壁和LA-PV交界处的瘢痕，而<0.45 mV的截止值最能识别其他位置的瘢痕。该电压范围（0.2 - 0.45 mV）有助于识别PV周围的重新连接区域。在DE CMRI上，0.27 mV的双极电压截止值在描绘瘢痕方面表现最佳（敏感性：90%，特异性：83%）。
在接受房颤消融的患者中，EAM得出的LA双极电压显示出区域差异。对于SR期间获取的图，0.2 - 0.45 mV的电压范围可准确划分LA瘢痕分布。这有助于识别接受再次房颤消融患者的PV重新连接。
