What question did this study set out to answer?

To evaluate whether atrial voltage reduction in patients with atrial fibrillation represents a diffuse fibrotic process and whether low-voltage areas reflect global rather than localized remodeling.

March 9, 2022Journal of the American Heart AssociationOpen Access

Atrial Structural Remodeling in Patients With Atrial Fibrillation Is a Diffuse Fibrotic Process: Evidence From High‐Density Voltage Mapping and Atrial Biopsy

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Why the study?

Low-voltage areas in atrial fibrillation are considered local fibrosis, but whether atrial voltage reduction is a diffuse process linked to fibrosis and whether low-voltage areas reflect global voltage reduction remained unverified.

Does high-density voltage mapping correlate with diffuse atrial fibrosis in patients with atrial fibrillation?

Population

140 patients with AF and 13 control patients with a left accessory pathway

Comparison

AF patients categorized by global LA voltage vs controls

Design

Cross-sectional physiological study

Discussion

Member takes

Implication

High-density voltage mapping demonstrates that voltage reduction in the left atrium of AF patients is a diffuse process that correlates strongly with histological fibrosis.

Key Points

To evaluate whether atrial voltage reduction in patients with atrial fibrillation represents a diffuse fibrotic process and whether low-voltage areas reflect global rather than localized remodeling.
Assessed 140 patients with atrial fibrillation and 13 control patients with a left accessory pathway using high-density bipolar grid mapping during high right atrial pacing.
Measured global left atrial voltage (divided into quartiles: Q1 <4.2 mV, Q2 4.2–5.6 mV, Q3 5.7–7.0 mV, Q4 ≥7.1 mV) and regional left atrial voltage across 6 anatomic regions, evaluating low-voltage areas at cutoffs of 0.1, 0.5, 1.0, and 1.5 mV.
Conducted right atrial septum biopsies in 28 patients with atrial fibrillation to quantify histological fibrosis extent and measure local voltage at the biopsy site.
Regional left atrial voltage decreased concurrently across all 6 anatomic regions as global voltage declined, with global and regional voltages in the highest quartile (Q4) showing no significant difference compared to controls.
The prevalence of low-voltage areas increased progressively as global left atrial voltage decreased across all defined voltage thresholds (0.1 to 1.5 mV).
Histological fibrosis measured 11±6% and correlated inversely with both biopsy site voltage (r = -0.71) and global left atrial voltage (r = -0.72), while local biopsy site voltage strongly correlated with global voltage (r = 0.82).

Structured PICO

Does high-density voltage mapping correlate with diffuse atrial fibrosis in patients with atrial fibrillation?

Population

140 patients with atrial fibrillation and 13 control patients with a left accessory pathway. A subset of 28 AF patients underwent right atrial septum biopsy.

Intervention

High-density bipolar voltage mapping using a grid-mapping catheter during high right atrial pacing

Comparator

Control patients with a left accessory pathway

Outcome

Global left atrial voltage (V GLA), regional LA voltage (V RLA), and extent of fibrosis on right atrial septum biopsysurrogate

High-density voltage mapping demonstrates that voltage reduction in the left atrium of AF patients is a diffuse process that correlates strongly with histological fibrosis.

Cite This Study

A 2022 study studied this question.

synapsesocial.com/papers/6a952e8a6a9a0c380125e47c https://doi.org/10.1161/jaha.121.024521

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Implication

High-density voltage mapping demonstrates that voltage reduction in the left atrium of AF patients is a diffuse process that correlates strongly with histological fibrosis.

Atrial Structural Remodeling in Patients With Atrial Fibrillation Is a Diffuse Fibrotic Process: Evidence From High‐Density Voltage Mapping and Atrial Biopsy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Atrial Structural Remodeling in Patients With Atrial Fibrillation Is a Diffuse Fibrotic Process: Evidence From High‐Density Voltage Mapping and Atrial Biopsy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

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