1
|
Li DL, Hajjar AHE, Ayoub T, Zhang Y, Huang C, Kholmovski EG, Mekhael M, Noujaim C, Feng H, Lim C, Marrouche NF. Left atrial volume affects the correlation of voltage map with magnetic resonance imaging. J Interv Card Electrophysiol 2024; 67:263-271. [PMID: 36973597 DOI: 10.1007/s10840-023-01522-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND 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. METHODS 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/m2 was defined as significant LA enlargement (LAE). RESULTS 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%). CONCLUSIONS 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.
Collapse
Affiliation(s)
- Dan L Li
- 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
| | | | - Tarek Ayoub
- 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
| | - Yichi Zhang
- Tulane Research and Innovation for Arrhythmia Discoveries, New Orleans, LA, USA
| | - Chao Huang
- Tulane Research and Innovation for Arrhythmia Discoveries, New Orleans, LA, USA
| | - Eugene G Kholmovski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Mario Mekhael
- Tulane Research and Innovation for Arrhythmia Discoveries, New Orleans, LA, USA
| | - Charbel Noujaim
- Tulane Research and Innovation for Arrhythmia Discoveries, New Orleans, LA, USA
| | - Han Feng
- Tulane Research and Innovation for Arrhythmia Discoveries, New Orleans, LA, USA
| | - Chanho Lim
- Tulane Research and Innovation for Arrhythmia Discoveries, New Orleans, LA, USA
| | - Nassir F Marrouche
- 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.
| |
Collapse
|
2
|
Spittler R, Witte N, Hoffmann BA, Marx A, Mollnau H, Quesada-Ocete B, Konrad T, Rostock T. Automated three-dimensional activation versus conventional mapping for catheter ablation of atrial tachycardia - A prospective randomized trial. Int J Cardiol Heart Vasc 2023; 47:101222. [PMID: 37252196 PMCID: PMC10220253 DOI: 10.1016/j.ijcha.2023.101222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/25/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
Background The automated NavX Ensite Precision latency-map (LM) algorithm aims to identify atrial tachycardia (AT) mechanisms. However, data on a direct comparison of this algorithm with conventional mapping are scarce. Methods Patients scheduled for AT ablation were randomized to mapping with the LM- algorithm (LM group) or to conventional mapping (conventional only group: ConvO), using entrainment and local activation mapping techniques. Several outcomes were exploratively analyzed. Primary endpoint was intraprocedural AT Termination. If AT termination with only automated 3D-Mapping failed, additional conventional methods were applied (conversion). Results A total of 63 patients (mean 67 years, 34 % female) were enrolled. In the LM group (n = 31), the correct AT mechanism was identified in 14 patients (45 %) using the algorithm alone compared to 30 patients (94 %) with conventional methods. Time to termination of the first AT was not different between groups (LM group 34 ± 20 vs. ConvO 43.1 ± 28.3 min; p = 0.2). However, when AT termination did not occur with LM algorithm, time to termination prolonged significantly (65 ± 35 min; p = 0.01). After applying conventional methods (conversion), procedural termination rates did not differ between LM group (90 %) vs. ConvO (94 %) (p = 0.3). During a follow-up time of 20 ± 9 months, no differences were observed in clinical outcomes. Conclusion In this small prospective, randomized study, the use of the LM algorithm alone may lead to AT termination, but less accurate than conventional methods.
Collapse
Affiliation(s)
- Raphael Spittler
- Corresponding author at: Department of Cardiology II/Electrophysiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Melby DP, Tholakanahalli VN, Itah R, Abdelhadi R, Sengupta J, Gornick CC, Moore J, Pai M, Benditt DG. Ripple Frequency Determined via a Novel Algorithm Is Associated With Atrial Fibrillation Termination and Freedom From Atrial Fibrillation. Heart Rhythm O2 2022; 3:665-72. [PMID: 36589915 DOI: 10.1016/j.hroo.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Persistent atrial fibrillation (AF) is a complex arrhythmia, and attaining freedom from AF with ablation has been challenging. Objectives This study evaluated a novel CARTO software algorithm based on the CARTO Ripple map for AF termination and 18-month freedom from AF. Methods Consecutive patients who underwent first-time ablation for persistent AF were included. A high-density Ripple map was created using a Pentaray catheter. Following PVI, ablation was performed at locations with rapid Ripple activations, a protocol previously described by us. Patients were followed for 18 months to assess rhythm outcomes. A retrospective analysis was performed using the CARTO Ripple frequency software algorithm. The Ripple frequency algorithm quantifies amplitude changes in the bipolar electrogram. Results A total of 115 AF maps were analyzed from 84 patients (mean age 65.9 years, 63.1% men). The top quartile of Ripple frequency corresponded to a visual reference with 96.7% sensitivity and 91.1% specificity. AF terminated during ablation in 88.1% of patients: pulmonary vein antrum alone (14.9%) or pulmonary vein plus nonantral sites (85.1%). The top quartile of Ripple frequency was present in nonantral areas associated with AF termination with 90.2% sensitivity and 86.5% specificity. After 14.0 ± 6.5 months and 1.2 ± 0.4 ablations, 78 (92.9%) of 84 patients were free of AF, and 79.8% were free of any atrial arrhythmia. Conclusion A novel algorithm for automated analysis of CARTO Ripple frequency demonstrated good sensitivity and specificity for detecting atrial regions in persistent AF in which ablation is associated with frequent AF termination and freedom from AF during follow-up.
Collapse
|
4
|
Plymen CM, Finlay M, Tsang V, O'leary J, Picaut N, Cullen S, Walker F, Deanfield JE, Hsia TY, Bolger AP, Lambiase PD. Haemodynamic consequences of targeted single- and dual-site right ventricular pacing in adults with congenital heart disease undergoing surgical pulmonary valve replacement. Europace 2014; 17:274-80. [PMID: 25371427 PMCID: PMC4309992 DOI: 10.1093/europace/euu281] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The purpose of this study was to create an epicardial electroanatomic map of the right ventricle (RV) and then apply post-operative-targeted single- and dual-site RV temporary pacing with measurement of haemodynamic parameters. Cardiac resynchronization therapy is an established treatment for symptomatic left ventricular (LV) dysfunction. In congenital heart disease, RV dysfunction is a common cause of morbidity-little is known regarding the potential benefits of CRT in this setting. METHODS AND RESULTS Sixteen adults (age = 32 ± 8 years; 6 M, 10 F) with right bundle branch block (RBBB) and repaired tetralogy of Fallot (n = 8) or corrected congenital pulmonary stenosis (n = 8) undergoing surgical pulmonary valve replacement (PVR) for pulmonary regurgitation underwent epicardial RV mapping and haemodynamic assessment of random pacing configurations including the site of latest RV activation. The pre-operative pulmonary regurgitant fraction was 49 ± 10%; mean LV end-diastolic volume (EDV) 85 ± 19 mL/min/m(2) and RVEDV 183 ± 89 mL/min/m(2) on cardiac magnetic resonance imaging. The mean pre-operative QRS duration is 136 ± 26 ms. The commonest site of latest activation was the RV free wall and DDD pacing here alone or combined with RV apical pacing resulted in significant increases in cardiac output (CO) vs. AAI pacing (P < 0.01 all measures). DDDRV alternative site pacing significantly improved CO by 16% vs. AAI (P = 0.018), and 8.5% vs. DDDRV apical pacing (P = 0.02). CONCLUSION Single-site RV pacing targeted to the region of latest activation in patients with RBBB undergoing PVR induces acute improvements in haemodynamics and supports the concept of 'RV CRT'. Targeted pacing in such patients has therapeutic potential both post-operatively and in the long term.
Collapse
Affiliation(s)
- Carla M Plymen
- Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK
| | - Malcolm Finlay
- Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK
| | - Victor Tsang
- Department of Cardiovascular Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Justin O'leary
- Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK
| | - Nathalie Picaut
- Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK
| | - Shay Cullen
- Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK
| | - Fiona Walker
- Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK
| | | | - T Y Hsia
- Department of Cardiovascular Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Aidan P Bolger
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
| | - Pier D Lambiase
- Department of Adult Congenital Heart Disease and Electrophysiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, 16-18 Westmoreland St, London W1G 8PH, UK UCL Institute of Child Health, London, UK
| |
Collapse
|