title: Endocardial voltage mapping of pulmonary veins with an ultra-high-resolution system to evaluate atrial myocardial extensions.
abstract: BACKGROUND
  Atrial fibrillation (AF) is mainly triggered by arrhythmogenic foci originating from atrial myocardial extensions (MEs) into the pulmonary veins (PVs). Aim of the study was to evaluate endocardial voltage maps of PVs as a surrogate parameter for the extent of MEs in subjects with AF through a ultra-high-density mapping system.
  
  
  METHODS
  Sixty-four bipolar electrograms were recorded simultaneously from the Orion mini-basket catheter placed in 72 PVs of 18 consecutive patients with paroxysmal/persistent AF undergoing PV isolation (PVI). The Rhythmia system in conjunction with the Orion mini-basket catheter was utilized to create a bipolar electro-anatomic reconstruction of the left atrium and PVs.
  
  
  RESULTS
  Mean patients' age was 61 ± 10 years, 56% had paroxysmal and 44% persistent AF. Mean endocardial bipolar voltages in the PVs were as follows: 1.06 ± 0.34 mV in right superior PV, 1.14 ± 0.52 mV in right inferior PV, 1.15 ± 0.44 mV in left superior PV and 0.94 ± 0.44 in left inferior PV. PVs had no detectable endocardial signals in 7 out of 72 PVs (9%); a total of 29/72 PVs (40%) revealed a non-uniform arrangement of MEs. The area of MEs was significantly larger in the superior PVs compared to the inferior PVs (9.3 ± 4.7 vs 6.7 ± 4 cm2, p = 0.002). No statistical differences in terms of MEs length were found among PVs and according to type of AF.
  
  
  CONCLUSIONS
  In this pilot study using a ultra-high-resolution electro-anatomical mapping system, endocardial voltage maps of PVs as a surrogate parameter of MEs among patients with AF well correspond to previous data from histopathological studies.
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany. dr.francesco.santoro.it@gmail.com.|Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. dr.francesco.santoro.it@gmail.com.
authors.forename: Francesco
authors.identifier: http://orcid.org/0000-0001-9909-6513
authors.initials: F
authors.lastname: Santoro
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Sohns
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Ardan M
authors.initials: AM
authors.lastname: Saguner
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Lemes
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Shibu
authors.initials: S
authors.lastname: Mathew
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Christian-H
authors.initials: CH
authors.lastname: Heeger
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Reißmann
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Maurer
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Riedl
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fink
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Cardiology, Asklepios Klinik, Lohmühlenstraße 5, St. Georg, 20099, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D004699:Endocardium; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D010865:Pilot Projects; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Myocardial extensions; Myocardial sleeves; Orion; Pulmonary veins; Rhythmia system; Sleeves; Voltage map