In AF patients undergoing repeat ablation, higher unipolar LVA burden predicted arrhythmia recurrence, and combining unipolar and bipolar metrics improved prediction accuracy.
Does combining unipolar and bipolar voltage mapping improve the prediction of atrial tachycardia and arrhythmia recurrence in AF patients undergoing repeat ablation?
Combining unipolar and bipolar voltage mapping improves the prediction of arrhythmia recurrence and atrial tachycardia in patients undergoing repeat ablation for atrial fibrillation.
Absolute Event Rate: 0% vs 0%
Abstract Background The significance of atrial low voltage areas (LVA) has increased in recent years, with studies linking LVA to ablation outcome and demonstrating their potential as ablation targets. While previous research primarily relied on bipolar voltage, recent data highlighted the importance of unipolar voltage in evaluating scars and detecting structural changes in the atrial walls. Objective To investigate the value of unipolar and bipolar voltages in detecting the presence of atrial tachycardia (AT) in atrial fibrillation (AF) patients and predating arrhythmia recurrence (AR) after repeated ablation procedures. Methods We conducted a retrospective analysis of 124 patients undergoing repeat ablation after failed pulmonary vein isolation (PVI). LVAs were quantified in high-density maps using cutoffs of 0.5 mV-bipolar and 2.5 mV-unipolar, excluding antral LVA from previous PVI. Feature configurations included unipolar, bipolar, and combined voltage metrics. Dispersion metrics (relative dispersion and mean-scaled difference) were calculated. A Random Forest Classifier modeled the association between voltage metrics and AT or AR after ≥15 months of follow-up. Results The cohort included 59% men, median age 69 years, with 34% recurrence-free at 15 months. Mean unipolar and bipolar LVA percentages were 26% ± 13% and 13% ± 10%, respectively. Key findings are detailed in Tables 1A&B. Patients with AR had significantly more unipolar LVA. Combining unipolar and bipolar metrics improved prediction accuracy and ROC-AUC, with the best performance achieved by incorporating all features. Conclusion In AF patients undergoing repeat ablation, a higher burden of unipolar LVAs was associated with AR. Combining data from unipolar and bipolar mapping improved prediction of AR and the presence of AT. This suggests that unipolar mapping may provide significant insights into the atrial substrate, supporting its integration alongside traditional bipolar mapping. Figure1 LA with Uni and bipolar voltage
Mohsen et al. (Sat,) reported a other. In AF patients undergoing repeat ablation, higher unipolar LVA burden predicted arrhythmia recurrence, and combining unipolar and bipolar metrics improved prediction accuracy.