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Quantitative assessment of left atrial scar using high-density voltage mapping and a novel automated voltage analysis tool

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Left atrial (LA) fibrosis plays an important role in the pathogenesis and perpetuation of atrial fibrillation (AF). It may be identified by bipolar voltage (BiV) mapping, but quantification of fibrosis which previously relied on visual estimation of scar has been shown to be inaccurate. Our aim was to use a novel automated voltage histogram analysis (VHA) tool to quantify LA scar burden accurately in patients with AF.

Methods

LA voltage was assessed in 100 consecutive patients undergoing first pulmonary vein isolation (PVI) for paroxysmal or persistent AF using a circular multielectrode catheter to create high-density LA BiV maps which were analysed using the VHA tool after the procedure.

Results

High-density electro-anatomic maps took 10 min to create and contained a median of 1049 points. The VHA algorithm accurately quantified the burden of Diseased LA Tissue (≤ 0.5 mV) and Dense LA Scar (≤ 0.2 mV) with a median of 17.8% and 3.5% respectively. A quartile classification was applied based on diseased LA tissue burden. Patients in class IV with the highest diseased LA burden were older (p < 0.0001), more likely female (p = 0.0095), had higher CHA2DS2-VASc scores (p = 0.0024) and were more likely to have persistent rather than paroxysmal AF (p = 0.0179) than those in classes I–III.

Conclusions

The VHA algorithm is able to quantify percentage surface area voltage rapidly and according to preset ranges for the first time. The algorithm offers the potential for classification of patients undergoing AF ablation into different classes of diseased LA burden, which may have diagnostic, therapeutic and prognostic implications.

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Acknowledgements

The technical support and assistance of Laura Deery, Gal Hayam and Tal Baron of Biosense-Webster® in the development and use of the voltage histogram analysis tool and in the provision of a laptop computer for offline analysis using the VHA tool is gratefully acknowledged.

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Authors and Affiliations

  1. Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary

    Szilvia Herczeg

  2. Heart and Vascular Centre, Mater Private Hospital, Eccles Street, Dublin 7, Ireland

    Katie Walsh, John J Keaney, Edward Keelan, John Travers, Gabor Szeplaki & Joseph Galvin

Authors
  1. Szilvia Herczeg
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  2. Katie Walsh
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  3. John J Keaney
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  4. Edward Keelan
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  5. John Travers
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  6. Gabor Szeplaki
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  7. Joseph Galvin
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Corresponding author

Correspondence to Joseph Galvin.

Ethics declarations

Informed consent was obtained from all individual participants included in the study. All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by our institutional research ethics committee. This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

GS reports personal fees from Johnson and Johnson Medical, Abbott and Biotronik; other authors have no conflicts of interests to declare.

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Herczeg, S., Walsh, K., Keaney, J.J. et al. Quantitative assessment of left atrial scar using high-density voltage mapping and a novel automated voltage analysis tool. J Interv Card Electrophysiol 59, 5–12 (2020). https://doi.org/10.1007/s10840-019-00570-7

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  • DOI: https://doi.org/10.1007/s10840-019-00570-7

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