Key result
Atrial pacing maps linked to faster mapping vs sinus rhythm but lower voltage and peak-frequency.
Why the study?
Atrial pacing maps are often used to substitute sinus rhythm maps to expedite mapping, but their impact on electrophysiological parameters has not been systematically examined.
Does left atrial substrate mapping during sinus-node pacing improve mapping time without compromising electrophysiological parameters compared to sinus rhythm mapping in patients undergoing AF ablation?
Observational (n=21)
Does left atrial substrate mapping during sinus-node pacing improve mapping time without compromising electrophysiological parameters compared to sinus rhythm mapping in patients undergoing AF ablation?
p-value: p=<0.01
Sinus-node pacing at 600 ms cycle length provides faster atrial substrate maps while maintaining acceptable electrophysiological information compared to sinus rhythm mapping.
May shorten AF ablation mapping time at lower voltages; leaves open impact on lesion durability.
INTRODUCTION: Atrial pacing maps are often used as substitutes for sinus rhythm (SR) maps to expedite mapping procedures. However, the impact of this method on electrophysiological parameters has not been systematically examined. This study aimed to elucidate the advantages and limitations of atrial pacing maps. METHODS AND RESULTS: In 21 patients undergoing catheter ablation for atrial fibrillation, left atrial (LA) substrate maps using an HD-grid catheter were performed during SR, and pacing from the sinus-node region with cycle lengths (CLs) of 300 ms (SN-P300) and 600 ms (SN-P600). Mapping time, omnipolar voltage, peak-frequency of electrograms, and global LA activation time were compared among the three maps. The SR-map more frequently required automap-setting changes (p < 0.01), and one SR-map was not completed due to CL-fluctuation. Compared to SR, mapping time significantly decreased (833 [702-1097] seconds for SR vs. 615 [530-700] seconds for SN-P600 and 463 [404-542] seconds for SN-P300, p < 0.01). Mean voltage and peak-frequency of electrograms significantly decreased in SN-P600 and SN-P300 (mean voltage: 2.5 [2.1-3.2] mV for SR vs. 2.3 [2.1-2.8] mV for SN-P600 and 2.2 [2.0-2.7] mV for SN-P300, p < 0.01; mean peak-frequency: 308 [299-325] Hz for SR vs. 303 [288-314] Hz for SN-P600 and 281 [258-295] Hz for SN-P300, p < 0.01). The wavefront collision site shifted in 3/20 (15%) between SR and SN-P600, remaing within 30° along the mitral annulus, but this shift reached 9/20 (45%) between SR and SN-P300, including one patient showing a shift up to 60°. CONCLUSION: SN-P maps provide faster, higher-resolution substrate maps, but the amplitude and frequency of electrograms may be reduced as the CL shortens. Maps with SN-P600 may be acceptable, maintaining electrophysiological information in SR.
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Shigeta et al. (2024) conducted an observational in Atrial fibrillation (n=21). Atrial pacing maps (SN-P300 and SN-P600) vs. Sinus rhythm (SR) maps was evaluated on Mapping time, omnipolar voltage, peak-frequency of electrograms, and global LA activation time (p=<0.01). Atrial pacing maps significantly decreased mapping time compared to sinus rhythm (463-615s vs 833s, p<0.01), but reduced mean voltage (2.2-2.3 vs 2.5 mV, p<0.01) and peak-frequency of electrograms.
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