Ali Syed Yusuf, Mohsen Yazan, Mao Yuncong, Sakata Kensuke, Kholmovski Eugene G, Prakosa Adityo, Yamamoto Carolyna, Loeffler Shane, Elia Marianna, Zandieh Ghazal, Stöckigt Florian, Horlitz Marc, Sinha Sunil Kumar, Marine Joseph, Calkins Hugh, Sommer Philipp, Sciacca Vanessa, Fink Thomas, Sohns Christian, Spragg David, Trayanova Natalia
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland; Department of Cardiology, Faculty of Health, School of Medicine, University Witten/Herdecke, Witten, Germany.
Heart Rhythm. 2024 Oct 11. doi: 10.1016/j.hrthm.2024.10.015.
In atrial fibrillation (AF) management, understanding left atrial (LA) substrate is crucial. While both electroanatomic mapping (EAM) and late gadolinium enhancement magnetic resonance imaging (LGE-MRI) are accepted methods for assessing the atrial substrate and are associated with ablation outcome, recent findings have highlighted discrepancies between low-voltage areas (LVAs) in EAM and LGE areas.
The purpose of this study was to explore the relationship between LGE regions and unipolar and bipolar LVAs using multipolar high-density mapping.
Twenty patients scheduled for AF ablation underwent preablation LGE-MRI. LA segmentation was conducted using a deep learning approach, which subsequently generated a 3-dimensional mesh integrating the LGE data. High-density EAM was performed in sinus rhythm for each patient. The electroanatomic map and LGE-MRI mesh were coregistered. LVAs were defined using cutoffs of 0.5 mV for bipolar voltage and 2.5 mV for unipolar voltage. The correspondence between LGE areas and LVAs in the LA was analyzed using confusion matrices and performance metrics.
A considerable 87.3% of LGE regions overlapped with unipolar LVAs, compared with only 16.2% overlap observed with bipolar LVAs. Across all performance metrics, unipolar LVAs outperformed bipolar LVAs in identifying LGE areas (precision: 78.6% vs 61.1%; sensitivity: 87.3% vs 16.2%; F score: 81.3% vs 26.0%; accuracy: 74.0% vs 35.3%).
Our findings demonstrate that unipolar LVAs strongly correlate with LGE regions. These findings support the integration of unipolar mapping alongside bipolar mapping into clinical practice. This would offer a nuanced approach to diagnose and manage AF by revealing critical insights into the complex architecture of the atrial substrate.
在心房颤动（AF）的管理中，了解左心房（LA）基质至关重要。虽然电解剖标测（EAM）和延迟钆增强磁共振成像（LGE-MRI）都是评估心房基质的公认方法，且与消融结果相关，但最近的研究结果突出了EAM中的低电压区域（LVA）与LGE区域之间的差异。
本研究的目的是使用多极高密度标测探索LGE区域与单极和双极LVA之间的关系。
20例计划进行AF消融的患者在消融前接受了LGE-MRI检查。使用深度学习方法进行LA分割，随后生成整合LGE数据的三维网格。对每位患者在窦性心律下进行高密度EAM。将电解剖图和LGE-MRI网格进行配准。使用双极电压0.5 mV和单极电压2.5 mV的阈值定义LVA。使用混淆矩阵和性能指标分析LA中LGE区域与LVA之间的对应关系。
相当大比例（87.3%）的LGE区域与单极LVA重叠，而与双极LVA的重叠仅为16.2%。在所有性能指标中，单极LVA在识别LGE区域方面优于双极LVA（精确度：78.6%对61.1%；灵敏度：87.3%对16.2%；F值：81.3%对26.0%；准确度：74.0%对35.3%）。
我们的研究结果表明，单极LVA与LGE区域密切相关。这些结果支持将单极标测与双极标测整合到临床实践中。这将通过揭示心房基质复杂结构的关键见解，为AF的诊断和管理提供一种细致入微的方法。
