Vol. 20 No. 2 (2016)
HEART RHYTHM DISORDERS

Voltage mapping as a method of left atrial fibrosis evaluation

O. Sapelnikov
Russian Cardiology Research and Production Complex, Ministry of Health Care of Russian Federation, 15a 3 Cherepkovskaya St., 121552, Mosсow
Bio
Yu. Shuvalova
Russian Cardiology Research and Production Complex, Ministry of Health Care of Russian Federation, 15a 3 Cherepkovskaya St., 121552, Mosсow
D. Cherkashin
Russian Cardiology Research and Production Complex, Ministry of Health Care of Russian Federation, 15a 3 Cherepkovskaya St., 121552, Mosсow
A. Krupnov
Russian Cardiology Research and Production Complex, Ministry of Health Care of Russian Federation, 15a 3 Cherepkovskaya St., 121552, Mosсow
A. Partigulova
Russian Cardiology Research and Production Complex, Ministry of Health Care of Russian Federation, 15a 3 Cherepkovskaya St., 121552, Mosсow
R. Akchurin
Russian Cardiology Research and Production Complex, Ministry of Health Care of Russian Federation, 15a 3 Cherepkovskaya St., 121552, Mosсow

Published 2016-08-17

Keywords

  • left atrial fibrosis,
  • voltage mapping,
  • fibrosis index,
  • atrial fibrillation.

How to Cite

Sapelnikov, O., Shuvalova, Y., Cherkashin, D., Krupnov, A., Partigulova, A., & Akchurin, R. (2016). Voltage mapping as a method of left atrial fibrosis evaluation. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 20(2), 111–116. https://doi.org/10.21688/1681-3472-2016-2-111-116

Abstract

Aim: This pilot study is designed to better understand the mechanisms of development and control of atrial fibrillation.
Methods: The correlation between fibrosis index (FI), which was calculated intraoperatively with special software, and clinical and instrumental data was analyzed. Also evaluated were FI values as compared to AF catheter ablation outcomes.
Results: Voltage mapping may be considered as a possible alternative to MRI examination and in some cases it is more informative.
Conclusion: It was found out that the preliminary results received are a good start for planning a large-scale study in this area related to assessment of the predicative and practical value of the fibrosis index.

References

  1. Gal P, Marrouche NF. Magnetic resonance imaging of atrial fibrosis: redefining atrial fibrillation to a syndrome. Eur Heart J. 2015 Sep 25. pii: ehv514. [Epub ahead of print].
  2. ElMaghawry M, Romeih S. DECAAF: Emphasizing the importance of MRI in AF ablation. Glob Cardiol Sci Pract. 2015;2015:8. http://dx.doi.org/5339/gcsp.2015.8. eCollection 2015
  3. Han FT, Marrouche N. An atrial fibrosis-based approach for atrial fibrillation ablation. Future Cardiol. 2015. [Epub ahead of print].
  4. Dzeshka MS, Lip GY, Snezhitskiy V, Shantsila E. Cardiac Fibrosis in Patients With Atrial Fibrillation: Mechanisms and Clinical Implications. J Am Coll Cardiol. 2015;66(8):943-59.
  5. Zhang L, Huang B, Scherlag BJ, Ritchey JW, Embi AA, Hu J, Hou Y, Po SS. Structural changes in the progression of atrial fibrillation: potential role of glycogen and fibrosis as perpetuating factors. Int J Clin Exp Pathol. 2015;8(2):1712-8.
  6. Yamashita T, Sekiguchi A, Suzuki S, Ohtsuka T, Sagara K, Tanabe H, Kunihara T, Sawada H, Aizawa T. Enlargement of the left atrium is associated with increased infiltration of immune cells in patients with atrial fibrillation who had undergone surgery. J Arrhythm. 2015;31(2):78-82.
  7. Krul SP, Berger WR, Smit NW, van Amersfoorth SC, Driessen AH, van Boven WJ, Fiolet JW, van Ginneken AC, van der Wal AC, de Bakker JM, Coronel R, de Groot JR. Atrial fibrosis and conduction slowing in the left atrial appendage of patients undergoing thoracoscopic surgical pulmonary vein isolation for atrial fibrillation. Circ Arrhythm Electrophysiol. 2015;8(2):288-95. http://dx.doi.org/1161/CIRCEP.114.001752
  8. Goldberger JJ, Arora R, Green D, Greenland P, Lee DC, Lloyd-Jones DM, Markl M, Ng J, Shah SJ. Evaluating the Atrial Myopathy Underlying Atrial Fibrillation: Identifying the Arrhythmogenic and Thrombogenic Substrate. 2015;132(4):278-91.
  9. Kosiuk J, Dinov B, Kornej J, Acou WJ, Schönbauer R, Fiedler L, Buchta P, Myrda K, Gąsior M, Poloński L, Kircher S, Arya A, Sommer P, Bollmann A, Hindricks G, Rolf S. Prospective, multicenter validation of a clinical risk score for left atrial arrhythmogenic substrate based on voltage analysis: DR-FLASH score. Heart Rhythm. 2015. pii: S1547-5271(15)00885-1. http://dx.doi.org/1016/j.hrthm.2015.07.003 [Epub ahead of print].
  10. Müller P, Maier J, Dietrich JW, Barth S, Griese DP, Schiedat F, Szöllösi A, Halbfass P, Nentwich K, Roos M, Krug J, Schade A, Schmitt R, Mügge A, Deneke T. Association between left atrial low-voltage area, serum apoptosis, and fibrosis biomarkers and incidence of silent cerebral events after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol. 2015;44(1):55-62. http://dx.doi.org/1007/s10840-015-0020-6
  11. Akoum N, Morris A, Perry D, Cates J, Burgon N, Kholmovski E, MacLeod R, Marrouche N. Substrate Modification Is a Better Predictor of Catheter Ablation Success in Atrial Fibrillation Than Pulmonary Vein Isolation: An LGE-MRI Study. Clin Med Insights Cardiol. 2015;9:25-31. http://dx.doi.org/4137/CMC.S22100
  12. Cutler MJ, Johnson J, Abozguia K, Rowan S, Lewis W, Costantini O, Natale A, Ziv O. Impact of Voltage Mapping to Guide Whether to Perform Ablation of the Posterior Wall in Patients With Persistent Atrial Fibrillation. J Cardiovasc Electrophysiol. 2015. http://dx.doi.org/1111/jce.12830 [Epub ahead of print].
  13. Letsas KP, Efremidis M, Sgouros NP, Vlachos K, Asvestas D, Sideris A. Catheter ablation of persistent atrial fibrillation: The importance of substrate modification. World J Cardiol. 2015;7(3):111-8. http://dx.doi.org/4330/wjc.v7.i3.111
  14. Akoum N, Wilber D, Hindricks G, Jais P, Cates J, Marchlinski F, Kholmovski E, Burgon N, Hu N, Mont L, Deneke T, Duytschaever M, Neumann T, Mansour M, Mahnkopf C, Hutchinson M, Herweg B, Daoud E, Wissner E, Brachmann J, Marrouche NF. MRI Assessment of Ablation-Induced Scarring in Atrial Fibrillation: Analysis from the DECAAF Study. J Cardiovasc Electrophysiol. 2015;26(5):473-80. http://dx.doi.org/1111/jce.12650
  15. Ling Z, McManigle J, Zipunnikov V, Pashakhanloo F, Khurram IM, Zimmerman SL, Philips B, Marine JE, Spragg DD, Ashikaga H, Calkins H, Nazarian S. The association of left atrial low-voltage regions on electroanatomic mapping with low attenuation regions on cardiac computed tomography perfusion imaging in patients with atrial fibrillation. Heart Rhythm. 2015;12(5):857-64. http://dx.doi.org/1016/j.hrthm.2015.01.015
  16. Malcolme-Lawes LC, Juli C, Karim R, Bai W, Quest R, Lim PB, Jamil-Copley S, Kojodjojo P, Ariff B, Davies DW, Rueckert D, Francis DP, Hunter R, Jones D, Boubertakh R, Petersen SE, Schilling R, Kanagaratnam P, Peters NS. Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: a 2-center study. Heart Rhythm. 2013;10(8):1184-91. http://dx.doi.org/1016/j.hrthm.2013.04.030
  17. Spragg DD, Khurram I, Zimmerman SL, Yarmohammadi H, Barcelon B, Needleman M, Edwards D, Marine JE, Calkins H, Nazarian S. Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation: success and limitations. Heart Rhythm. 2012;9(12):2003-9. http://dx.doi.org/1016/j.hrthm.2012.08.039
  18. Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. 1994;89:724-730.
  19. Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P; STAR AF II Investigators. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372(19):1812-22. http://dx.doi.org/1056/NEJMoa1408288
  20. Bunch TJ, Cutler MJ. Is pulmonary vein isolation still the cornerstone in atrial fibrillation ablation? J Thorac Dis. 2015;7(2):132-41. http://dx.doi.org/3978/j.issn.2072-1439.2014.12.46