Gigli Lorenzo, Preda Alberto, Coluzzi Davide, Sartore Marta, Vila Muhamed, Carbonaro Marco, Baroni Matteo, Varrenti Marisa, Vargiu Sara, Guarracini Fabrizio, Frontera Antonio, Pannone Luigi, Chierchia Gian Battista, De Asmundis Carlo, Mazzone Patrizio, Sassi Roberto
De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, Italy.
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium.
Front Physiol. 2024 Nov 27;15:1474568. doi: 10.3389/fphys.2024.1474568. eCollection 2024.
Electrical remodeling has been linked to the progression and recurrence of atrial fibrillation (AF) after catheter ablation (CA). Substrate mapping based solely on a voltage amplitude electrogram (EGM) does not provide a comprehensive understanding of the left atrial (LA) disease. The aim of this study is to assess left atrial spatial entropy (LASE) from voltage maps routinely obtained during AF ablation to further characterize the LA substrate.
High-density electroanatomic maps (EAMs) of 27 patients with paroxysmal or persistent AF undergoing routine CA were prospectively collected. Computational post-processing was performed on the voltage maps. Using the Shannon entropy model, the probability distribution of the amplitude range values associated with each point of the map was used to measure LASE. Finally, correlations between LASE and clinical and electrophysiological characteristics of AF were explored.
LASE differentiated between patients with paroxysmal and persistent AF (6.45 ± 0.41 vs. 5.87 ± 0.53; = 0.028) and patients with normal and abnormal LA substrate (6.42 ± 0.42 vs. 5.87 ± 0.56; = 0.043), independent of the basal rhythm during EM acquisition (6.33 ± 0.41 vs. 6.11 ± 0.63; = 0.619). Accordance between LASE and EAMs was assessed by ROC analysis (AUC: 0.81; C.I.: 0.62-0.99; Youden index: 6.06; sensitivity: 80%; and specificity: 80%). Patients with the lowest LASE reported AF recurrence at the follow-up.
LASE may play a role in the further characterization of the LA substrate and the type of AF, independent of basal rhythm.
电重构与导管消融（CA）术后心房颤动（AF）的进展和复发有关。仅基于电压幅度电图（EGM）的基质标测不能全面了解左心房（LA）疾病。本研究的目的是通过在AF消融期间常规获取的电压图评估左心房空间熵（LASE），以进一步表征LA基质。
前瞻性收集了27例接受常规CA的阵发性或持续性AF患者的高密度电解剖图（EAM）。对电压图进行计算后处理。使用香农熵模型，利用与图上每个点相关的幅度范围值的概率分布来测量LASE。最后，探讨LASE与AF的临床和电生理特征之间的相关性。
LASE可区分阵发性和持续性AF患者（6.45±0.41对5.87±0.53；P = 0.028）以及LA基质正常和异常的患者（6.42±0.42对5.87±0.56；P = 0.043），与EM采集期间的基础心律无关（6.33±0.41对6.11±0.63；P = 0.619）。通过ROC分析评估LASE与EAM之间的一致性（AUC：0.81；C.I.：0.62 - 0.99；约登指数：6.06；敏感性：80%；特异性：80%）。LASE最低的患者在随访中出现AF复发。
LASE可能在LA基质和AF类型的进一步表征中发挥作用，与基础心律无关。
