Details

Autor(en) / Beteiligte

• Yamaguchi, Takanori
• Otsubo, Toyokazu
• Takahashi, Yuya
• Nakashima, Kana
• Fukui, Akira
• Hirota, Kei
• Ishii, Yumi
• Shinzato, Kodai
• Osako, Ryosuke
• Tahara, Mai
• Kawano, Yuki
• Kawaguchi, Atsushi
• Aishima, Shinichi
• Takahashi, Naohiko
• Node, Koichi

Titel

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

Ist Teil von

• Journal of the American Heart Association, 2022-03, Vol.11 (6), p.e024521-e024521

Ort / Verlag

England: John Wiley and Sons Inc

Erscheinungsjahr

2022

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Low-voltage areas (LVAs) in the atria of patients with atrial fibrillation are considered local fibrosis. We hypothesized that voltage reduction in the atria is a diffuse process associated with fibrosis and that the presence of LVAs reflects a global voltage reduction. Methods and Results We examined 140 patients with atrial fibrillation and 13 patients with a left accessory pathway (controls). High-density bipolar voltage mapping was performed using a grid-mapping catheter during high right atrial pacing. Global left atrial (LA) voltage (V ) in the whole LA and regional LA voltage (V ) in 6 anatomic regions were evaluated with the mean of the highest voltage at a sampling density of 1 cm . Patients with atrial fibrillation were categorized into quartiles by V . LVAs were evaluated at voltage cutoffs of 0.1, 0.5, 1.0, and 1.5 mV. Twenty-eight patients with atrial fibrillation also underwent right atrial septum biopsy, and the fibrosis extent was quantified. Voltage at the biopsy site (V ) was recorded. V results by category were Q1 (<4.2 mV), Q2 (4.2-5.6 mV), Q3 (5.7-7.0 mV), and Q4 (≥7.1 mV). V at any region was reduced as V decreased. V and V did not differ between Q4 and controls. The presence of LVAs increased as V decreased at any voltage cutoff. Biopsies revealed 11±6% fibrosis, which was inversely correlated with both V and V ( =-0.71 and -0.72, respectively). V was correlated with V ( =0.82). Conclusions Voltage reduction in the LA is a diffuse process associated with fibrosis. Presence of LVAs reflects diffuse voltage reduction of the LA.