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Left atrial volume affects the correlation of voltage map with magnetic resonance imaging

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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.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Authors and Affiliations

  1. Cardiac Electrophysiology Section, Department of Internal Medicine and Cardiology, Tulane University School of Medicine, New Orleans, LA, 70112, USA

    Dan L. Li, Tarek Ayoub & Nassir F. Marrouche

  2. Tulane Research and Innovation for Arrhythmia Discoveries, New Orleans, LA, USA

    Dan L. Li, Abdel Hadi El Hajjar, Tarek Ayoub, Yichi Zhang, Chao Huang, Mario Mekhael, Charbel Noujaim, Han Feng, Chanho Lim & Nassir F. Marrouche

  3. Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA

    Eugene G. Kholmovski

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  1. Dan L. Li
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Correspondence to Nassir F. Marrouche.

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This is a retrospective data collection from procedures performed at our center. The study was approved by the Institutional Review Board of our institution.

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Li, D.L., Hajjar, A.H.E., Ayoub, T. et al. Left atrial volume affects the correlation of voltage map with magnetic resonance imaging. J Interv Card Electrophysiol 67, 263–271 (2024). https://doi.org/10.1007/s10840-023-01522-y

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