title: Does the extent of left atrial arrhythmogenic substrate depend on the electroanatomical mapping technique: impact of pulmonary vein mapping catheter vs. ablation catheter.
abstract: OBJECTIVE
  In persistent atrial fibrillation (AF), left atrial low-voltage areas and complex fractionated atrial electrograms (CFAEs) have been thoroughly discussed as critical substrate points for AF perpetuation. Thus, in patients undergoing pulmonary vein isolation, these sites are often considered additional ablation targets. Currently, mapping techniques for these substrate indicators are still under discussion. The aim of this study was to evaluate the impact of different mapping catheters on the detection of low-voltage areas and CFAE.
  
  
  RESULTS
  Two bipolar voltage maps and two CFAE left atrial maps were obtained each in 30 patients undergoing catheter ablation of AF using the following two different catheters: A four-pole ablation catheter (MAP, mapping and ablation catheter) (electrode size: tip: 4 mm, band: 1 mm; inter-electrode spacing: 0.5-5-2 mm) and a 10-pole circular pulmonary vein mapping catheter (CMC) (electrode size: 1 mm; inter-electrode spacing: 7-7-7 mm). Successively, low-voltage and CFAE area sizes were then compared between the two catheters. Areas with a bipolar voltage of <0.5 mV were significantly smaller when obtained with the CMC compared with the MAP (8.9 ± 8.9 vs. 17.4 ± 11.7 cm², P < 0.001). This was also significantly different for a bipolar voltage of <0.2 mV (2.3 ± 4.6 vs. 6.2 ± 9.6 cm², P < 0.001). Complex fractionated atrial electrogram area sizes were significantly larger when obtained with the CMC compared with the MAP group (14.6 ± 10.9 vs. 19.4 ± 9.4 cm², P = 0.011).
  
  
  CONCLUSIONS
  Low-voltage and CFAE area size varies significantly between different mapping catheters. Mapping electrode settings have to be taken into consideration for the assessment of electroanatomical substrate of AF.
authors.affiliation: Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, Berlin D-13553, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Huemer
authors.affiliation: Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, Berlin D-13553, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Qaiyumi
authors.affiliation: Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, Berlin D-13553, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Attanasio
authors.affiliation: Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, Berlin D-13553, Germany.
authors.forename: Abdul
authors.initials: A
authors.lastname: Parwani
authors.affiliation: Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, Berlin D-13553, Germany.|Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany.
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.affiliation: Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, Berlin D-13553, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Blaschke
authors.affiliation: Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, Berlin D-13553, Germany.
authors.forename: Leif-Hendrik
authors.initials: LH
authors.lastname: Boldt
authors.affiliation: Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, Berlin D-13553, Germany.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Haverkamp
authors.affiliation: Department of Cardiology, St. Josef-Hospital, Clinic of the Ruhr-University Bochum.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wutzler
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000295:instrumentation*; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted
keywords: Atrial fibrillation; CFAE; Catheter ablation; Complex fractionated atrial electrograms; Electrode size; Inter-electrode spacing; Low voltage; Mapping; Substrate