Li Dan L, Hajjar Abdel Hadi El, Ayoub Tarek, Zhang Yichi, Huang Chao, Kholmovski Eugene G, Mekhael Mario, Noujaim Charbel, Feng Han, Lim Chanho, Marrouche Nassir F
Cardiac Electrophysiology Section, Department of Internal Medicine and Cardiology, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
Tulane Research and Innovation for Arrhythmia Discoveries, New Orleans, LA, USA.
J Interv Card Electrophysiol. 2024 Mar;67(2):263-271. doi: 10.1007/s10840-023-01522-y. Epub 2023 Mar 27.
The low-voltage area detected by electroanatomic mapping (EAM) is a surrogate marker of left atrial fibrosis. However, the correlation between the EAM and late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been inconsistent among studies. This study aimed to investigate how LA size affects the correlation between EAM and LGE-MRI.
High-density EAMs of the LA during sinus rhythm were collected in 22 patients undergoing AF ablation. The EAMs were co-registered with pre-ablation LGE-MRI models. Voltages in the areas with and without LGE were recorded. Left atrial volume index (LAVI) was calculated from MRI, and LAVI > 62 ml/m was defined as significant LA enlargement (LAE).
Atrial bipolar voltage negatively correlates with the left atrial volume index. The median voltages in areas without LGE were 1.1 mV vs 2.0 mV in patients with vs without significant LAE (p = 0.002). In areas of LGE, median voltages were 0.4 mV vs 0.8 mV in patients with vs without significant LAE (p = 0.02). A voltage threshold of 1.7 mV predicted atrial LGE in patients with normal or mildly enlarged LA (sensitivity and specificity of 74% and 59%, respectively). In contrast, areas of voltage less than 0.75 mV correlated with LGE in patients with significant LA enlargement (sensitivity 68% and specificity 66%).
LAVI affects left atrial bipolar voltage, and the correlation between low-voltage areas and LGE-MRI. Distinct voltage thresholds according to the LAVI value might be considered to identify atrial scar by EAM.
通过电解剖标测（EAM）检测到的低电压区域是左心房纤维化的替代标志物。然而，EAM与延迟钆增强磁共振成像（LGE-MRI）之间的相关性在不同研究中并不一致。本研究旨在探讨左心房大小如何影响EAM与LGE-MRI之间的相关性。
收集22例接受房颤消融术患者在窦性心律时的左心房高密度EAM。将EAM与消融前LGE-MRI模型进行配准。记录有和无LGE区域的电压。通过MRI计算左心房容积指数（LAVI），LAVI>62 ml/m²定义为显著左心房扩大（LAE）。
心房双极电压与左心房容积指数呈负相关。有和无显著LAE患者中，无LGE区域的中位电压分别为1.1 mV和2.0 mV（p = 0.002）。在LGE区域，有和无显著LAE患者的中位电压分别为0.4 mV和0.8 mV（p = 0.02）。1.7 mV的电压阈值可预测左心房正常或轻度扩大患者的心房LGE（敏感性和特异性分别为74%和59%）。相比之下，在左心房显著扩大的患者中，电压小于0.75 mV的区域与LGE相关（敏感性68%，特异性66%）。
LAVI影响左心房双极电压以及低电压区域与LGE-MRI之间的相关性。根据LAVI值可考虑采用不同的电压阈值通过EAM识别心房瘢痕。
