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.
Division of Cardiac Electrophysiology, Department of Cardiology Houston Methodist Hospital, Houston, Texas.
JACC Clin Electrophysiol. 2018 Dec;4(12):1541-1552. doi: 10.1016/j.jacep.2018.08.015. Epub 2018 Nov 1.
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.
It is unclear if bipolar voltage cutoffs should be adjusted depending on the rhythm and/or area being mapped.
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.
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.
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.
本研究旨在：1）使用多电极快速自动标测确定窦性心律（SR）与心房颤动（AF）/心房扑动（AFL）之间的电压相关性；2）确定瘢痕和/或低电压区（LVA）的双极电压截断值；3）检查 AF 中电压标测的可重复性。
目前尚不清楚是否应根据节律和/或正在标测的区域调整双极电压截断值。
首先在 SR 中进行高密度标测，然后在诱导的 AF/AFL 中进行。在一些患者中，在 AF 期间进行了 2 次标测。将地图组合以创建新地图。分析差值<1mm 的点。使用散点图探索相关性，并使用 Bland-Altman 图评估一致性分析。还应用了广义加性模型。
共获得 2002 对配对点。AFL 中的 0.35 mV 截断值可预测窦性电压为 0.5 mV（95%置信区间[CI]：0.12 至 2.02），AF 中的 0.24 mV（95%CI：0.11 至 2.18；特异性[SP]：0.94 和 0.96；敏感性[SE]：0.85 和 0.75）。当使用广义加性模型时，AFL 中的 0.38 mV 截断值用于预测 SR 中最小 0.5 mV 值（95%CI：0.5 至 1.6；SP：0.94，SE：0.88）和 AF 中的 0.31 mV（95%CI：0.5 至 1.2；SP：0.95，SE：0.82）。关于 AF 地图，除了房顶之外，左心房的任何区域的分类都没有改变。
可以建立新的 AFL 和/或 AF 截断值，用于预测<0.5 mV 的窦性电压，具有可接受的有效性。在 AFL 和/或 AF 中进行多电极快速自动标测似乎在分类 LVA 时是可靠和可重复的。这些观察结果对左心房电压分布以及在使用瘢痕分布指导肺静脉隔离和/或再隔离的程序中具有临床意义。
