ArticleHeart rhythm O22025
High-density evaluation of the arrhythmogenic substrate in persistent atrial fibrillation.
Article in Heart rhythm O2, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
Background: Left atrial (LA) fibrosis is a key component of arrhythmogenic remodeling in atrial fibrillation (AF). LA low-voltage areas (LVAs) are considered surrogates for fibrosis and novel targets for ablation. However, there are no established criteria for identifying such potential pathogenic areas, particularly when using omnipolar technology (OT) mapping. Objective: This study aimed to evaluate the correlation between OT and conventional bipolar voltage (BiV) in AF and regular rhythms. Methods: Bipolar and OT mapping was performed in 17 patients undergoing de novo ablation for persistent AF. Mapping was performed in AF and coronary sinus pacing (CSP) at 600 ms. BiV of <0.5 mV was defined as low voltage. Results: LA voltage in AF correlated poorly with CSP using either BiV (r = 0.15) or OT (r = 0.16). OT yielded higher voltages than BiV in AF (0.62 ± 0.24 vs 0.49 ± 0.18 mV, Conclusion: The mapping tool and atrial rhythm significantly influence LA voltage and LVA burden for both bipolar and OT mapping. Applying a universal bipolar or OT cutoff for low voltage in AF and sinus rhythm will not accurately reflect the arrhythmogenic substrate. OT yields higher voltage than corresponding bipolar measurements; thus, threshold adjustments are required when using OT.
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