Quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillation
Abstract Background The clinical significance of left atrial local electrogram fractionation after restoration of sinus rhythm in patients with atrial fibrillation (AF) has not been elucidated. Methods We evaluated ultrahigh‐resolution maps of the left atrium (LA) during RA pacing acquired after pul...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-02-01
|
| Series: | Journal of Arrhythmia |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/joa3.12971 |
| _version_ | 1827356435192741888 |
|---|---|
| author | Takayuki Sekihara Takafumi Oka Kentaro Ozu Yasushi Sakata |
| author_facet | Takayuki Sekihara Takafumi Oka Kentaro Ozu Yasushi Sakata |
| author_sort | Takayuki Sekihara |
| collection | DOAJ |
| description | Abstract Background The clinical significance of left atrial local electrogram fractionation after restoration of sinus rhythm in patients with atrial fibrillation (AF) has not been elucidated. Methods We evaluated ultrahigh‐resolution maps of the left atrium (LA) during RA pacing acquired after pulmonary vein isolation in 40 patients with AF. The association between low‐voltage area (LVA, <0.5 mV), fractionated electrogram area (FEA, the highlighted area with LUMIPOINT™ Complex Activation), the interval from onset of LA activation to wavefront collision at the mitral isthmus (LA activation time), and wave propagation velocity (WPV) was evaluated quantitatively. Results The total LVA, total FEA with ≥5.0 peaks or ≥7.0 peaks were 7.0 ± 7.9 cm2, 15.9 ± 12.9 cm2, and 5.2 ± 7.5 cm2, respectively. These areas were predominantly observed in the anteroseptal region. Total LVA, total FEA with ≥5.0 peaks, and total FEA with ≥5.0 peaks in the normal voltage area (NVA: ≥0.5 mV) correlated with LA activation time (R = 0.69, 0.75, and 0.71; each p < .0001). In the anterior wall, these areas correlated with regional mean WPV (R = −0.75, −0.83, and − 0.55; each p < .0001) and the extent of slow conduction area (SCA) with WPV <0.3 m/s (R = 0.89, 0.84, 0.33; p < .0001 for LVA and FEA, p < .05 for FEA located in NVA). The anterior wall FEA with ≥7.0 peaks and that in the NVA showed a better correlation in predicting anterior wall SCA (R = 0.92 and 0.86, each p < .0001). Conclusion Quantitative analysis of FEA together with LVA may facilitate the assessment of LA electrical remodeling. |
| first_indexed | 2024-03-08T04:59:52Z |
| format | Article |
| id | doaj.art-e3095e6a3bc64f68862744d1dd9e3870 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 1883-2148 |
| language | English |
| last_indexed | 2024-03-08T04:59:52Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-e3095e6a3bc64f68862744d1dd9e38702024-02-07T13:08:43ZengWileyJournal of Arrhythmia1880-42761883-21482024-02-01401909910.1002/joa3.12971Quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillationTakayuki Sekihara0Takafumi Oka1Kentaro Ozu2Yasushi Sakata3Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka JapanAbstract Background The clinical significance of left atrial local electrogram fractionation after restoration of sinus rhythm in patients with atrial fibrillation (AF) has not been elucidated. Methods We evaluated ultrahigh‐resolution maps of the left atrium (LA) during RA pacing acquired after pulmonary vein isolation in 40 patients with AF. The association between low‐voltage area (LVA, <0.5 mV), fractionated electrogram area (FEA, the highlighted area with LUMIPOINT™ Complex Activation), the interval from onset of LA activation to wavefront collision at the mitral isthmus (LA activation time), and wave propagation velocity (WPV) was evaluated quantitatively. Results The total LVA, total FEA with ≥5.0 peaks or ≥7.0 peaks were 7.0 ± 7.9 cm2, 15.9 ± 12.9 cm2, and 5.2 ± 7.5 cm2, respectively. These areas were predominantly observed in the anteroseptal region. Total LVA, total FEA with ≥5.0 peaks, and total FEA with ≥5.0 peaks in the normal voltage area (NVA: ≥0.5 mV) correlated with LA activation time (R = 0.69, 0.75, and 0.71; each p < .0001). In the anterior wall, these areas correlated with regional mean WPV (R = −0.75, −0.83, and − 0.55; each p < .0001) and the extent of slow conduction area (SCA) with WPV <0.3 m/s (R = 0.89, 0.84, 0.33; p < .0001 for LVA and FEA, p < .05 for FEA located in NVA). The anterior wall FEA with ≥7.0 peaks and that in the NVA showed a better correlation in predicting anterior wall SCA (R = 0.92 and 0.86, each p < .0001). Conclusion Quantitative analysis of FEA together with LVA may facilitate the assessment of LA electrical remodeling.https://doi.org/10.1002/joa3.12971atrial fibrillationatrial remodelingatrial substrateconduction velocityultrahigh‐resolution mapping |
| spellingShingle | Takayuki Sekihara Takafumi Oka Kentaro Ozu Yasushi Sakata Quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillation Journal of Arrhythmia atrial fibrillation atrial remodeling atrial substrate conduction velocity ultrahigh‐resolution mapping |
| title | Quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillation |
| title_full | Quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillation |
| title_fullStr | Quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillation |
| title_full_unstemmed | Quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillation |
| title_short | Quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillation |
| title_sort | quantitative analysis of fractionated electrogram area of left atrium during right atrial pacing as an indicator of left atrial electrical remodeling in patients with atrial fibrillation |
| topic | atrial fibrillation atrial remodeling atrial substrate conduction velocity ultrahigh‐resolution mapping |
| url | https://doi.org/10.1002/joa3.12971 |
| work_keys_str_mv | AT takayukisekihara quantitativeanalysisoffractionatedelectrogramareaofleftatriumduringrightatrialpacingasanindicatorofleftatrialelectricalremodelinginpatientswithatrialfibrillation AT takafumioka quantitativeanalysisoffractionatedelectrogramareaofleftatriumduringrightatrialpacingasanindicatorofleftatrialelectricalremodelinginpatientswithatrialfibrillation AT kentaroozu quantitativeanalysisoffractionatedelectrogramareaofleftatriumduringrightatrialpacingasanindicatorofleftatrialelectricalremodelinginpatientswithatrialfibrillation AT yasushisakata quantitativeanalysisoffractionatedelectrogramareaofleftatriumduringrightatrialpacingasanindicatorofleftatrialelectricalremodelinginpatientswithatrialfibrillation |