Key result
Local conduction velocity calculation during coronary sinus pacing yielded similar distributions across patients (median CVs 0.26-0.36), limiting its ability to identify atrial substrate complexity.
Why the study?
PVI is ineffective in up to 60% of persistent AF patients due to non-pulmonary vein drivers, prompting exploration of local conduction velocity during pacing as an indicator of left atrial substrate complexity.
Does local conduction velocity during coronary sinus pacing identify left atrial substrate complexity in patients with atrial fibrillation?
Observational (n=7)
Does local conduction velocity during coronary sinus pacing identify left atrial substrate complexity in patients with atrial fibrillation?
Calculating local conduction velocity during coronary sinus pacing using sequential CARTO mapping is feasible but does not reliably identify atrial fibrillation substrate complexity due to similar CV distributions among patients.
Local CV during CS pacing may not identify AF substrate; hypothesis-generating in case reports and requires larger validation.
Background: Pulmonary vein isolation (PVI) as treatment for atrial fibrillation (AF) is not effective in up to 60% of patients with persistent AF; AF drivers outside of the pulmonary veins can contribute to AF recurrences after PVI. In this study we explored the potential use of local conduction velocity (CV) during pacing as a marker of left atrial (LA) substrate complexity.Methods: LA activation times were recorded for 7 AF patients during coronary sinus (CS) pacing before PVI using a Pentaray catheter. Activation times were relative to the CS pacing spike. LA activation locations were triangularized to calculate CV: the local direction and speed of the activation wave front. CV was quantified by the total CV distribution.Results: A mean of 1622 CVs were calculated per patient. Distribution of CVs showed a similar morphology, with median CVs in the range [0.26, 0.36] and interquartile ranges in the range [0.29, 0.39].Conclusion: This study shows that although it is feasible to calculate CVs based on sequential CARTO mapping of the LA during CS pacing, the resulting distribution of CVs using this procedure is not necessarily able to identify substrate complexity because of the large similarity between distributions and the relatively small differences in medians.
No takes yet. Share an insight, caveat, or question.
Rosmalen et al. (2019) conducted an observational in Atrial fibrillation (n=7). Local conduction velocity calculation during coronary sinus pacing was evaluated on Local conduction velocity (CV) distribution. Local conduction velocity calculation during coronary sinus pacing yielded similar distributions across patients (median CVs 0.26-0.36), limiting its ability to identify atrial substrate complexity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: