title: Correlation of Left Atrial Voltage Distribution Between Sinus Rhythm and Atrial Fibrillation: Identifying Structural Remodeling by 3-D Electroanatomic Mapping Irrespective of the Rhythm.
abstract: Left atrial (LA) electroanatomical voltage mapping (EAVM) correlates with scar on LGE-MRI and has been used to guide ablation of low voltage area (LVA) in sinus rhythm (SR). We compared EAVM in SR and AF in a cohort of AF patients, and in SR between patients with AF and without AF or structural heart disease (control).
  
  
  
  Twenty-seven AF patients, 9 with paroxysmal AF (PAF), underwent point-by-point EAVM during SR and AF using same Carto3 geometry. Only adjacent SR-AF points (≤ 5 mm apart) were compared. In addition, 6 control patients were evaluated. There was a linear bipolar voltage correlation between SR and AF (r = 0.707, P < 0.001, Y = 1.515X + 0.786). LA bipolar voltage in patients with PAF was higher than those with Non-PAF in SR (2.24 ± 1.51 vs. 1.56 ± 1.53 mV) and AF (0.81 ± 0.60 vs. 0.58 ± 0.62 mV, both for P < 0.001). The pulmonary vein antra voltage was significantly lower than other LA regions in PAF (1.28 ± 0.79 vs. 2.54 ± 1.50 mV, P < 0.001) and Non-PAF patients (1.13 ± 1.04 vs. 1.86 ± 1.72 mV, P < 0.001), while no voltage differences was found in the control group (P = 0.998).
  
  
  
  There was a linear voltage correlation between SR and AF, suggesting a similar extent of LA fibrotic substrate can be identified on EAVM by adjusting the voltage cutoff. Structural remodeling starts in the PV antra and may progress to other LA regions.
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Yagishita
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: DE Oliveira
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cakulev
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: J Rod
authors.initials: JR
authors.lastname: Gimbel
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Dina
authors.initials: D
authors.lastname: Sparano
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Harish
authors.initials: H
authors.lastname: Manyam
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Manrique-Garcia
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Arredondo
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Mackall
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Arruda
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D016022:Case-Control Studies; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005355:Fibrosis; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
keywords: atrial fibrillation; atrial remodeling; catheter ablation; electroanatomical mapping; pulmonary vein