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. 2023 Aug;14(4):268-278.
doi: 10.14740/cr1503. Epub 2023 Jul 12.

Comparing Left Atrial Low Voltage Areas in Sinus Rhythm and Atrial Fibrillation Using Novel Automated Voltage Analysis: A Pilot Study

James Mannion  1 , Kathryn Hong  1   2 , Sarah-Jane Lennon  1 , Anthony Kenny  3 , Joseph Galvin  1 , Jim O'Brien  1 , Gael Jauvert  1 , Edward Keelan  1 , Usama Boles  1   4   5
Affiliations

Comparing Left Atrial Low Voltage Areas in Sinus Rhythm and Atrial Fibrillation Using Novel Automated Voltage Analysis: A Pilot Study

James Mannion et al. Cardiol Res. 2023 Aug.

Abstract

Background: Low voltage areas (LVAs) have been proposed as surrogate markers for left atrial (LA) scar. Correlation between voltages in sinus rhythm (SR) and atrial fibrillation (AF) have previously been measured via point-by-point analysis. We sought to compare LA voltage composition measured in SR to AF, utilizing a high-density automated voltage histogram analysis (VHA) tool in those undergoing pulmonary vein isolation (PVI) for persistent AF (PeAF).

Methods: We retrospectively analyzed patients with PeAF undergoing de novo PVI. Maps required ≥ 1,000 voltage points in each rhythm and had a standardized procedure (mapped in AF then remapped in SR post-PVI). We created six anatomical segments (AS) from each map: anterior, posterior, roof, floor, septal and lateral AS. These were analyzed by VHA, categorizing atrial LVAs into 10 voltage aliquots 0 - 0.5 mV. Data were analyzed using SPSS v.26.

Results: We acquired 58,342 voltage points (n = 10 patients, mean age: 67 ± 13 years, three females). LVA burdens of ≤ 0.2 mV, designated as "severe LVAs", were comparable between most AS (except on the posterior wall) with good correlation. Mapped voltages between the ranges of 0.21 and 0.5 mV were labeled as "diseased LA tissue", and these were found significantly more in AF than SR. Significant differences were seen on the roof, anterior, posterior, and lateral AS.

Conclusions: Diseased LA tissue (0.21 - 0.5 mV) burden is significantly higher in AF than SR, mainly in the anterior, roof, lateral, and posterior wall. LA "severe LVA" (≤ 0.2 mV) burden is comparable in both rhythms, except with respect to the posterior wall. Our findings suggest that mapping rhythm has less effect on the LA with voltages < 0.2 mV than 0.2 - 0.5 mV across all anatomical regions, excluding the posterior wall.

Keywords: Left atrial low voltage area burden; Persistent atrial fibrillation; Radiofrequency ablation; Voltage histogram analysis.

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Conflict of interest statement

No conflict of interest to report.

Figures

Figure 1
Figure 1
Left atrial AS. Demonstration of left atrial AS boarders with example of each anatomical region in place during analysis via VHA. (a) Anterior AS. (b) Roof AS. (c) Floor AS. (d) Posterior AS. (e) Septal AS. (f) Lateral AS. AS: anatomical segment; VHA: voltage histogram analysis.
Figure 2
Figure 2
Breakdown of data. Map diagram demonstrating number of patients and breakdown of data points. All combined maps comprised 58,342 voltage points split among 10 patients. Each patient had two maps, one in SR and one in AF. These maps were divided into six AS, giving us 12 AS per patient and 120 in total. Each AS was divided into 10 voltage aliquots between 0 and 0.5 mV, giving us 1,200 voltage aliquots/data points for comparison. LVA: low voltage area; SR: sinus rhythm; AF: atrial fibrillation; AS: anatomical segment.
Figure 3
Figure 3
*Denotes significance. Correlation coefficient scatterplots. Scatterplots demonstrating correlation coefficients between rhythms at different ranges, ≤ 0.2 mV (group 1) and 0.21 - 0.5 mV (group 2). (a, b) Roof AS in group 1 and 2, respectively. (c, d) Lateral AS in group 1 and group 2, respectively. (e, f) Anterior AS in group 1 and 2, respectively. (g, h) Septal AS in group 1 and group 2, respectively. (i, j) Floor AS in group 1 and group 2, respectively. (k, l) Posterior AS in group 1 and 2, respectively. AS: anatomical segment.
See this image and copyright information in PMC

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