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Kuo MJ, Ton ANK, Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Tuan TC, Chao TF, Liao JN, Chang TY, Lin CY, Kuo L, Wu CI, Liu CM, Cheng WH, Liu SH, Chhay C, Kao PH, Chen WT, Hsu CY, Chen SA. Abnormal Conduction Zone Detected by Isochronal Late Activation Mapping Accurately Identifies the Potential Atrial Substrate and Predicts the Atrial Fibrillation Ablation Outcome After Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol 2023; 16:e011149. [PMID: 36688314 DOI: 10.1161/circep.122.011149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The presence of abnormal substrate of left atrium is a predictor of atrial fibrillation (AF) recurrence after pulmonary vein isolation. We aimed to investigate the isochronal late activation mapping to access the abnormal conduction velocity for predicting AF ablation outcome. METHODS Forty-five paroxysmal AF patients (30 males, 57.8±8.7 years old) who underwent pulmonary vein isolation were enrolled. Isochronal late activation mapping was retrospectively constructed with 2 different windows of interest: from onset of P wave to onset of QRS wave on surface electrocardiography (W1) and 74 ms tracking back from the end of P wave (W2). Deceleration zone was defined as regions with 3 isochrones (DZa) or ≥4 isochrones (DZb) within a 1 cm radius on the isochronal late activation mapping, and the estimated conduction velocity (ECV) are 0.27 m/s and <0.20 m/s for DZa and DZb, respectively in W2. The distribution of deceleration zone was compared with the location of low-voltage zone (bipolar voltage ≤0.5 mV). Any recurrence of atrial arrhythmias was defined as the primary end point during follow ups after a 3-month blanking period. RESULTS Pulmonary vein isolation was performed in all patients, and there were 2 patients (4.4%) received additional extrapulmonary vein ablation. After a mean follow-up of 12.7±4.5 months, recurrence of AF occurred in 14 patients (31.1%). Patients with the presence of DZb in W2 had higher AF recurrence (Kaplan-Meier event rate estimates: HR, 9.41 [95% CI, 2.61-33.90]; log-rank P<0.0001). There were 52.6% of the DZb locations in W2 comparable to the distributions of low-voltage zone and 47.4% DZb were distributed in the area without low-voltage zone. CONCLUSIONS Deceleration zone detected by isochronal late activation mapping represents a critical AF substrate, it accurately predicts the AF recurrence following ablation in patients with paroxysmal AF.
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Affiliation(s)
- Ming-Jen Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.).,Cardiovascular Center, Taichung Veterans General Hospital (M.-J.K., S.-A.C.)
| | - An Nu-Khanh Ton
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Tam Duc Heart hospital, Vietnam (A.N.-K.T.)
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Ting-Yung Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Ling Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Cheng-I Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Chih-Min Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Wen-Han Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Shin-Huei Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Chheng Chhay
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Pei-Heng Kao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Wei-Tso Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Chu-Yu Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.)
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital (M.-J.K., A.N.-K.T., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., C.C., P.-H.K., W.-T.C., C.-Y.H., S.-A.C.).,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming Chiao-Tung University, Taipei (M.-J.K., L.-W.L., Y.-J.L., S.-L.C., Y.-F.H., F.-P.C., T.-C.T., T.-F.C., J.-N.L., T.-Y.C., C.-Y.L., L.K., C.-I.W., C.-M.L., W.-H.C., S.-H.L., S.-A.C.).,Cardiovascular Center, Taichung Veterans General Hospital (M.-J.K., S.-A.C.).,National Chung Hsing University, Taichung, Taiwan (S.-A.C.)
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