Mannion James, Galvin Joseph, Boles Usama
Cardiology Department, Heart and Vascular Centre Mater Private Hospital Dublin Ireland.
J Arrhythm. 2020 Sep 2;36(6):967-973. doi: 10.1002/joa3.12421. eCollection 2020 Dec.
Identification and quantification of low voltage areas (LVA) in atrial fibrillation (AF), identified by their bipolar voltages (BiV) via electro-anatomical voltage mapping is an area of interest to prognosis of AF free burden. LVAs have been linked to diseased left atrial (LA) tissue which results in pro-fibrillatory potentials. These LVAs are dominantly found within the pulmonary veins, however, as the disease progresses other areas of the LA show low voltage. The scar burden of the LA is linked to recurrence of the arrhythmia and can be a target of further modification. This burden is classically assessed once sinus rhythm (SR) is attained, but this is susceptible to operator variability with overestimated dense LA scar (<0.2 mV) and underestimated diseased LA tissue (<0.5 mV). The novel automated voltage histogram analysis (VHA) tool may increase accuracy, however, is yet to be fully validated. A recent study indicates that LVAs can be assessed just as reliably in AF as SR, but BiV is lower with linear correlation to SR values (0.24-0.5 mV respectively). In this paper, we review current data as well as review current methods of identifying, quantifying, and grading LA scar. We also compared AF vs SR voltages of a patient undergoing catheter ablation in our site using our VHA tool to compare the results. In keeping with the cited papers, we found lower voltages in our patient measured in AF. This area warrants further study to assess correlation in more patients, with view to developing prognostic and therapeutic grading systems.
通过电解剖电压标测识别心房颤动（AF）中的低电压区域（LVA）并对其进行量化，这是一个与无房颤负担预后相关的研究领域。LVA与患病的左心房（LA）组织有关，后者会产生促颤电位。这些LVA主要存在于肺静脉内，然而，随着疾病进展，LA的其他区域也会出现低电压。LA的瘢痕负荷与心律失常的复发有关，可能是进一步治疗的靶点。这种负荷通常在恢复窦性心律（SR）后进行评估，但这容易受到操作者差异的影响，可能会高估致密LA瘢痕（<0.2mV）和低估患病LA组织（<0.5mV）。新型自动电压直方图分析（VHA）工具可能会提高准确性，但尚未得到充分验证。最近的一项研究表明，在AF中评估LVA与在SR中评估一样可靠，但双极电压（BiV）较低，与SR值呈线性相关（分别为0.24 - 0.5mV）。在本文中，我们回顾了当前的数据以及识别、量化和分级LA瘢痕的当前方法。我们还使用我们的VHA工具比较了在我们机构接受导管消融的一名患者在AF和SR时的电压，以比较结果。与引用的论文一致，我们发现该患者在AF时测量的电压较低。该领域值得进一步研究，以评估更多患者中的相关性，以期开发预后和治疗分级系统。
