What is the clinical evidence from this study?

Study design: Observational. Population: Persistent atrial fibrillation (n=18). Intervention: Low-voltage zones (LVZs <0.5 mV) vs. Non-low-voltage zones (non-LVZs ≥0.5 mV). Primary outcome: Mean conduction velocity at 600 ms (p=<.001).

What question did this study set out to answer?

To evaluate the relationship between left atrial bipolar voltage, conduction velocity dynamics across varying pacing rates, and the localization of atrial fibrillation driver sites.

July 17, 2018Heart RhythmOpen Access

Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation

Q: What are the key findings of this study?

Low-voltage zones (<0.5 mV) exhibited significantly slower mean conduction velocity at 600 ms compared to non-low-voltage zones (0.98 vs 1.59 m/s; P<0.001).

Q: What question did this study set out to answer?

To evaluate the relationship between left atrial bipolar voltage, conduction velocity dynamics across varying pacing rates, and the localization of atrial fibrillation driver sites.

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Key result

Low-voltage zones exhibit ~38% slower conduction velocity at 600 ms versus non-low-voltage zones.

P<.001
n=18

Key Points

To evaluate the relationship between left atrial bipolar voltage, conduction velocity dynamics across varying pacing rates, and the localization of atrial fibrillation driver sites.
Enrolled 18 patients (mean age 62 ± 10 years) with persistent atrial fibrillation (<24 months) undergoing catheter ablation.
Recorded unipolar electrograms with a 64-pole basket catheter during sinus rhythm pacing at 4 pacing intervals (600, 350, 300, and 250 ms).
Calculated conduction velocities across bipolar voltage zones (low-voltage zones <0.5 mV vs non-low-voltage zones ≥0.5 mV) and correlated rate-dependent slowing sites with rotational drivers mapped via CARTOFINDER.
Mean conduction velocity at 600 ms pacing was significantly lower in low-voltage zones compared to non-low-voltage zones (0.98 ± 0.23 m/s vs 1.59 ± 0.13 m/s; P < .001).
Conduction velocity decreased incrementally across all pacing intervals in low-voltage zones, and rate-dependent slowing sites were predominantly localized to low-voltage areas (0.2–0.5 mV; 75.6% ± 15.5%; P < .001).
Confirmed rotational drivers co-localized with rate-dependent conduction slowing sites in 94.1% of cases (sensitivity 94.1%, 95% CI 71.3%–99.9%; specificity 77.9%, 95% CI 74.9%–80.7%).

Study Design

Type

Observational (n=18)

Structured PICO

Population

18 patients undergoing catheter ablation for persistent AF (<24 months), mean age 62 ± 10 years.

Intervention

Unipolar electrogram recording with a 64-pole basket catheter during atrial pacing at 4 pacing intervals during sinus rhythm.

Comparator

Comparison of conduction velocity dynamics between low-voltage zones (LVZs <0.5 mV) and non-LVZs (≥0.5 mV).

Outcome

Relationship between bipolar voltage, conduction velocity dynamics, and AF drivers mapped using CARTOFINDER.surrogate

Main Result

Absolute Event Rate: 0.98% vs 1.59%

p-value: p=<.001

Rate-dependent conduction velocity slowing is predominantly confined to low-voltage zones, creating heterogeneity that may promote driver formation in persistent atrial fibrillation.

Discussion

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Implication

May promote rotational drivers in persistent AF; hypothesis-generating for substrate-targeted ablation strategies.

Cite This Study

Honarbakhsh et al. (2018) conducted an observational in Persistent atrial fibrillation (n=18). Low-voltage zones (LVZs <0.5 mV) vs. Non-low-voltage zones (non-LVZs ≥0.5 mV) was evaluated on Mean conduction velocity at 600 ms (p=<.001). Low-voltage zones (<0.5 mV) exhibited significantly slower mean conduction velocity at 600 ms compared to non-low-voltage zones (0.98 vs 1.59 m/s; P<0.001).

synapsesocial.com/papers/6a0d2909d7cdc72b86656692 https://doi.org/10.1016/j.hrthm.2018.07.019

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Structural remodeling and conduction velocity dynamics in the human left atrium: Relationship with reentrant mechanisms sustaining atrial fibrillation

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider