Sim Iain, Bishop Martin, O'Neill Mark, Williams Steven E
Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor North Wing, St. Thomas' Hospital, 249 Westminster Bridge Road, London, SE1 7EH, UK.
J Interv Card Electrophysiol. 2019 Dec;56(3):213-227. doi: 10.1007/s10840-019-00537-8. Epub 2019 May 10.
Low atrial endocardial bipolar voltage, measured during catheter ablation for atrial fibrillation (AF), is a commonly used surrogate marker for the presence of atrial fibrosis. Low voltage shows many useful associations with clinical outcomes, comorbidities and has links to trigger sites for AF. Several contemporary trials have shown promise in targeting low voltage areas as the substrate for AF ablation; however, the results have been mixed. In order to understand these results, a thorough understanding of voltage mapping techniques, the relationship between low voltage and the pathophysiology of AF, as well as the inherent limitations in voltage measurement are needed. Two key questions must be answered in order to optimally apply voltage mapping as the road map for ablation. First, are the inherent limitations of voltage mapping small enough as to be ignored when targeting specific tissue based on voltage? Second, can conventional criteria, using a binary threshold for voltage amplitude, truly define the extent of the atrial fibrotic substrate? Here, we review the latest clinical evidence with regard to voltage-based ablation procedures before analysing the utility and limitations of voltage mapping. Finally, we discuss omnipole mapping and dynamic voltage attenuation as two possible approaches to resolving these issues.
在心房颤动（AF）导管消融期间测量的低位心房心内膜双极电压，是心房纤维化存在的常用替代标志物。低电压与临床结局、合并症有许多有益的关联，并且与房颤的触发部位有关。一些当代试验已显示出将低电压区域作为房颤消融基质的前景；然而，结果喜忧参半。为了理解这些结果，需要全面了解电压标测技术、低电压与房颤病理生理学之间的关系以及电压测量的固有局限性。为了最佳地将电压标测用作消融路线图，必须回答两个关键问题。第一，基于电压靶向特定组织时，电压标测的固有局限性是否小到可以忽略不计？第二，使用电压幅度的二元阈值的传统标准能否真正定义心房纤维化基质的范围？在此，我们在分析电压标测的实用性和局限性之前，回顾了有关基于电压的消融程序的最新临床证据。最后，我们讨论全极点标测和动态电压衰减这两种可能解决这些问题的方法。
