Sinus rhythm voltage fingerprinting in patients with mitral valve disease using a high-density epicardial mapping approach

Figures

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  Figure 1. Upper left panel: projection of the 192-unipolar electrode array on a schematic posterior view of the atria. Lower left panel: epicardial, unipolar potentials recorded during 5 s of SR containing atrial deflections (A) and far-field ventricular signals (V). Typical examples of nine unipolar potentials obtained from the RA are shown outside the mapping. Right panel: classification of potential type according to the number of deflections (f). Electrogram voltage is determined as the peak-to-peak amplitude of the steepest (primary) deflection. BB, Bachmann’s Bundle; FDT, fractionation delay time; ICV, inferior caval vein; LAA, left atrial appendage; LA, left atrium; PV, pulmonary veins; RAA, right atrial appendage; RA, right atrium; SCV, superior caval vein.

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  Figure 2. Relation between potential amplitude and number of deflections [median (25th–75th percentile)].

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  Figure 3. Representative examples of unipolar epicardial voltage maps during one sinus beat in six patients without history of AF (left) and six patients with PAF (right). (P)AF, (paroxysmal) atrial fibrillation.

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  Figure 4. Boxplots of the voltage distributions during SR depicted for each patient separately without AF recorded at the RA, BB, PVA, and LA. For each patient, a pie plot of the potential type distribution is given, indicating the number of SPs (turquoise) and FPs (red). For each patient, a green line indicates a patient’s voltage p5 and the lilac line represents the overall voltage median per atrial region. Patients are ranked in descending order according to the amount of SPs at BB. AF, atrial fibrillation; BB, Bachmann’s bundle; FP, fractionated potentials; LA, left atrium; PVA, pulmonary vein area; RA, right atrium; SP, single potentials; SR, sinus rhythm.

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  Figure 5. Boxplots of the voltage distributions during SR depicted for each patient separately with PAF recorded at the RA, BB, PVA, and LA. For each patient a pie plot of the potential type distribution is given, indicating the number of SPs (turquoise) and FPs (red). For each patient, a green line indicates a patient’s voltage p5 and the lilac line represents the overall voltage median per atrial region. Patients are ranked in descending order according to the amount of single potentials at BB. BB, Bachmann’s bundle; FP, fractionated potentials; LA, left atrium; PAF, paroxysmal atrial fibrillation; PVA, pulmonary vein area; RA, right atrium; SP, single potentials; SR, sinus rhythm.

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  Figure 6. Bars plotted on a schematic posterior view of the atria demonstrating the most prominent site of low-voltage areas (left panel) and amount of low voltage (right panel) depicted for patients without AF (turquoise/green) and with PAF (red/lilac) in the RA, BB, PVA, and LA. BB, Bachmann’s bundle; LA, left atrium; (P)AF, (paroxysmal) atrial fibrillation; PVA, pulmonary vein area; RA, right atrium.