The presence of nonuniform isochrone-areas on the left atrial low-posterior wall was an independent indicator for non-pulmonary vein triggers (OR 6.9; 95% CI 1.1-44.1; p=0.040).
Observational (n=62)
Does the presence of nonuniform isochrone-areas in late activation mapping indicate arrhythmogenic substrates related to atrial fibrillation in patients undergoing catheter ablation?
Identification of nonuniform isochrone-areas on the left atrial low-posterior wall during late activation mapping may help localize potential sources of non-pulmonary vein triggers in patients with atrial fibrillation.
Odds Ratio: 6.9 (95% CI 1.1–44.1)
p-value: p=0.040
ABSTRACT Introduction Arrhythmogenic substrates within the atrial myocardium may contribute to the initiation of atrial fibrillation (AF). The relationship between nonuniform isochrone‐areas in late activation mapping and arrhythmogenic substrates remains undetermined. Methods Sixty‐two patients (66 ± 10 years, 47 males, non‐paroxysmal AF n = 30, second ablation procedure n = 8) who undergoing catheter ablation for AF were enrolled. High‐density left atrial (LA) activation mapping was performed during atrial pacing after pulmonary vein (PV) isolation. Late activation mapping was retrospectively reconstructed. Nonuniform isochrone‐areas were defined as regions of nonuniform and mottled conduction‐zones characterized by the crowding of ≥ 3 color‐isochrones within a 1‐cm radius in late activation mapping. The relationship between nonuniform isochrone‐areas and arrhythmogenic substrates associated with AF was evaluated. Results Non‐PV triggers were identified in 11 patients (AF‐triggers:12; short runs of premature atrial complexes:4), located in the LA wall (posterior:7; anterior:6; septum:2; roof:1). Patients with non‐PV triggers had significantly more nonuniform isochrone‐areas than those without (median interquartile range 5.0 3.0–6.0 vs. 2.0 1.0–4.0, p < 0.001). In multivariate logistic analysis for the presence of non‐PV triggers, after adjusting for confounders such as non‐paroxysmal AF, heart failure‐history, and presence of low‐voltage areas, the presence of nonuniform isochrone‐areas on the LA low‐posterior wall was an independent indicator for the presence of non‐PV triggers (odds ratio: 6.9 95% CI:1.1–44.1, p = 0.040). Of the 52 nonuniform isochrone‐areas observed in the 11 patients with non‐PV triggers, 20 areas corresponded to non‐PV trigger sites. Conclusion Identification of nonuniform isochrone‐areas located on LA low‐posterior wall in late activation mapping may indicate the potential source for non‐PV triggers.
Watanabe et al. (Tue,) conducted a observational in Atrial fibrillation (n=62). Nonuniform isochrone-areas on the LA low-posterior wall vs. Absence of nonuniform isochrone-areas was evaluated on Presence of non-pulmonary vein triggers (OR 6.9, 95% CI 1.1-44.1, p=0.040). The presence of nonuniform isochrone-areas on the left atrial low-posterior wall was an independent indicator for non-pulmonary vein triggers (OR 6.9; 95% CI 1.1-44.1; p=0.040).