Multimodal Examination of Atrial Fibrillation Substrate. Correlation of Left Atrial Bipolar Voltage Using Multi-Electrode Fast Automated Mapping, Point-by-Point Mapping, and Magnetic Resonance Image Intensity Ratio

Tarek Zghaib, Ali Keramati, Jonathan Chrispin, Dong Huang, Muhammad A. Balouch, Luisa Ciuffo, Ronald D Berger, Joseph Marine, Hiroshi Ashikaga, Hugh Calkins, Saman Nazarian, David D Spragg

Research output: Contribution to journalArticle

Abstract

Objectives: The aim of this study was to examine atrial fibrillation (AF) substrate using different modalities (point-by-point [PBP], fast anatomic mapping [FAM], and late gadolinium enhancement [LGE] magnetic resonance imaging [MRI] mapping) in patients presenting for AF ablation. Background: Bipolar voltage mapping, as part of AF ablation, is traditionally performed in a PBP approach using single-tip ablation catheters. Alternative techniques for fibrosis delineation include FAM with multi-electrode circular catheters and LGE MRI. The correlation between PBP, FAM, and LGE-MRI fibrosis assessment is unknown. Methods: LGE MRI was performed pre-ablation in 26 patients (73% men, mean age 63 ± 8 years). Local image intensity ratio (IIR) was used to normalize myocardial intensities. PBP and FAM voltage maps were acquired, in sinus rhythm, prior to ablation and coregistered with LGE MRI. Results: The mean bipolar voltage for all 19,087 FAM voltage points was 0.88 ± 1.27 mV, and the average IIR was 1.08 ± 0.18. In an adjusted mixed-effects model, each unit increase in local IIR was associated with a 57% decrease in bipolar voltage (p < 0.0001). An IIR >0.74 corresponded to a bipolar voltage <0.5 mV. A total of 1,554 PBP mapping points were matched to the nearest FAM point. In an adjusted mixed-effects model, log FAM bipolar voltage was significantly associated with log PBP bipolar voltage (β = 0.36, p < 0.0001). At low voltages, FAM distribution was shifted to the left compared with PBP mapping; at intermediate voltages, FAM and PBP voltages were overlapping; and at high voltages, FAM voltages exceeded PBP voltages. Conclusions: LGE-MRI, FAM, and PBP mapping showed good correlation in delineating electroanatomic AF substrate. Each approach has fundamental technical characteristics, the awareness of which allows proper assessment of atrial fibrosis.

Original languageEnglish (US)
JournalJACC: Clinical Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2017

Keywords

  • Atrial fibrillation
  • Fibrosis
  • Magnetic resonance imaging
  • Substrate
  • Voltage mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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