The association of left atrial low-voltage regions on electroanatomic mapping with low attenuation regions on cardiac computed tomography perfusion imaging in patients with atrial fibrillation

Zhiyu Ling, John McManigle, Vadim Zipunnikov, Farhad Pashakhanloo, Irfan M. Khurram, Stefan L. Zimmerman, Binu Philips, Joseph E. Marine, David D. Spragg, Hiroshi Ashikaga, Hugh Calkins, Saman Nazarian

Research output: Contribution to journalArticle


Background Previous studies have shown that contrast-enhanced multidetector computed tomography (CE-MDCT) could identify ventricular fibrosis after myocardial infarction. However, whether CE-MDCT can characterize atrial low-voltage regions remains unknown. Objective The purpose of this study was to examine the association of CE-MDCT image attenuation with left atrial (LA) low bipolar voltage regions in patients undergoing repeat ablation for atrial fibrillation recurrence. Methods We enrolled 20 patients undergoing repeat ablation for atrial fibrillation recurrence. All patients underwent preprocedural 3-dimensional CE-MDCT of the LA, followed by voltage mapping (>100 points) of the LA during the ablation procedure. Epicardial and endocardial contours were manually drawn around LA myocardium on multiplanar CE-MDCT axial images. Segmented 3-dimensional images of the LA myocardium were reconstructed. Electroanatomic map points were retrospectively registered to the corresponding CE-MDCT images. Results A total of 2028 electroanatomic map points obtained in sinus rhythm from the LA endocardium were registered to the segmented LA wall CE-MDCT images. In a linear mixed model, each unit increase in the local image attenuation ratio was associated with 25.2% increase in log bipolar voltage (P =.046) after adjusting for age, sex, body mass index, and LA volume, as well as clustering of data by patient and LA regions. Conclusion We demonstrate that the image attenuation ratio derived from CE-MDCT is associated with LA bipolar voltage. The potential ability to image fibrosis via CE-MDCT may provide a useful alternative in patients with contraindications to magnetic resonance imaging.

Original languageEnglish (US)
Article number6086
Pages (from-to)857-864
Number of pages8
JournalHeart Rhythm
Issue number5
StatePublished - May 1 2015



  • Atrial fibrillation
  • Cardiac computed tomography perfusion imaging
  • Electroanatomic mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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