Root-mean-square voltage measurement was significantly better than peak negative voltage at predicting low-voltage during atrial fibrillation using sinus rhythm voltage (61% vs 15%, P<0.05).
Observational (n=20)
Does RMS voltage measurement improve the agreement of electrogram voltage mapping between sinus rhythm and atrial fibrillation compared to peak voltage measurement in patients with paroxysmal AF?
RMS amplitude provides better agreement between sinus rhythm and atrial fibrillation voltages than conventional peak voltage, suggesting it may be a more reliable metric for substrate mapping.
Absolute Event Rate: 61% vs 15%
p-value: p=<0.05
INTRODUCTION: The peak electrogram voltage is a typical metric applied at each site for voltage mapping. However, the peak amplitude depends on the direction and complexity of the wavefront propagation. The root-mean-square (RMS) measure of the amplitude is a temporal integral that represents the steady-state value. The objective of this study was to investigate the disparities between the electrogram voltage during SR and AF by using 2 recording modalities: the conventional peak voltage and an RMS measurement. METHODS AND RESULTS: This study enrolled 20 patients (age = 59 +/- 13) with paroxysmal AF undergoing catheter ablation guided by Ensite array. The unipolar electrogram voltage during SR and AF (7 seconds in duration) was obtained from the same sites, and labeled by the 3-dimensional (3D) geometry. Overall 1,200 electrograms were analyzed from equally distributed mapping sites in the left atrium. A point-by-point comparison of the unipolar peak negative voltage (PNV) showed less agreement (Bland and Altman test: 10.4% outside 2 standard deviations, and intraclass correlation coefficient ICC= 0.64). The RMS voltage demonstrated agreement between SR and AF for all sites (BA test: 5.9% of the sites, and the ICC = 0.81). The probability of predicting a low-voltage during AF using the voltage during SR was significantly lower when using the PNV measurement compared to that when using the RMS voltage (15% vs 61%, P < 0.05). CONCLUSION: The peak electrogram unipolar voltage during AF did not represent the voltage during SR. The RMS amplitude may be an alternative metric for voltage mapping to characterize the myocardial substrate.
CHANG et al. (Tue,) conducted a observational in Paroxysmal atrial fibrillation (n=20). Root-mean-square (RMS) voltage measurement vs. Peak negative voltage (PNV) measurement was evaluated on Probability of predicting a low-voltage during AF using the voltage during SR (p=<0.05). Root-mean-square voltage measurement was significantly better than peak negative voltage at predicting low-voltage during atrial fibrillation using sinus rhythm voltage (61% vs 15%, P<0.05).