title: The relationship between endocardial voltage and regional volume in electroanatomical remodeled left atria in patients with atrial fibrillation: comparison of three-dimensional computed tomographic images and voltage mapping.
abstract: BACKGROUND
  Long-standing atrial fibrillation (AF) changes left atrial (LA) morphology, and the LA size is related to recurrence after radiofrequency catheter ablation (RFCA). We hypothesize that LA morphology, based on embryological origin, affects the outcome of RFCA.
  
  
  METHODS
  We analyzed 3D computed tomographic (CT) images of LA in 70 patients with AF (54 males, 55.6 +/- 10.5 years old, paroxysmal AF (PAF):persistent AF (PeAF) = 32:38) who underwent RFCA. Each LA image was divided into venous atrium (VA), anterior LA (ALA), LA appendage (LAA), and both antrum. Absolute and relative volumes were calculated, and the lengths of linear ablation sites were measured.
  
  
  RESULTS
  (1) In patients with the mean LA voltage < or = 2.0 mV, LA volume, especially ALA, was larger (P < 0.01) compared to those with LA voltage > 2.0 mV. (2) The total LA volume was significantly larger (P < 0.01) and LAA voltages (P < 0.05) and conduction velocities (P < 0.05) were lower in patients with PeAF than in those with PAF. (3) In patients with recurrence, LA volume was generally larger (P < 0.01) than in those without recurrence. In PAF patients with recurrence, the relative volume of ALA was significantly larger (P < 0.01) than those without recurrence.
  
  
  CONCLUSIONS
  Morphologically remodeled LA has low endocardial voltage, and enlargement of ALA is more significant in electroanatomically remodeled LA. The disproportional enlargement of ALA was observed more often in PAF patients with recurrence after ablation than those without recurrence.
authors: Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea.
authors: Jae Hyung
authors: JH
authors: Park
authors: Hui-Nam
authors: HN
authors: Pak
authors: Eun Jeoung
authors: EJ
authors: Choi
authors: Jin Kun
authors: JK
authors: Jang
authors: Sook Kyoung
authors: SK
authors: Kim
authors: Dong Hoon
authors: DH
authors: Choi
authors: Jong Il
authors: JI
authors: Choi
authors: Chun
authors: C
authors: Hwang
authors: Young-Hoon
authors: YH
authors: Kim
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004699:Endocardium / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*