The role of high-density mapping in atrial fibrillation ablation

Aims. To determine the role of the prevalence of low-voltage areas in the occurrence of arrhythmia recurrence after interventional treatment of atrial fibrillation (AF). Methods. The study included 38 patients with paroxysmal (52.6%) and persistent (47.4%) forms of AF who underwent interventional treatment of AF using high-density electroanatomical mapping (at least 10,000 EGM points). Analysis of electroanatomical maps was performed after the completion of the ablation procedure. The area of the low-voltage zones was measured manually. Then, the areas of all regions of low-voltage activity were summed up; the resulting value was expressed as a percentage of the total surface area of the left atrium (LA). Results. The observation period was 12.8±3.2 months. Based on the results of endocardial mapping, all patients were divided into 2 groups according to the prevalence of low-voltage areas in the LA. The first group included patients with an area of low-voltage zones less than 5% of the total surface of the left atrium, and the second with an area of low-voltage areas of more than 5% of the total surface of the left atrium. The patients of the first group had a lower LA volume compared to patients from the second group, with mean values of 119.87±16.35 ml and 154.57±33.23 ml, respectively (p=0.007). In the first group, AF recurrence was recorded in one patient after catheter treatment, in the second group in 5 patients. Conclusion. Common areas of low-voltage activity in the left atrium, detected by high-density mapping before the procedure for catheter treatment of AF, are a predictor of arrhythmia recurrence after interventional treatment.