Low voltage zones detected by omnipolar Vmax map accurately identifies the potential atrial substrate and predicts the AF ablation outcome after PV isolation

Ming Jen Kuo, Li Wei Lo, Yenn Jiang Lin, Shih Lin Chang, Yu Feng Hu, Fa Po Chung, Ta Chuan Tuan, Tze Fan Chao, Jo Nan Liao, Ting Yung Chang, Chin Yu Lin, Ling Kuo, Cheng I. Wu, Chih Min Liu, Wen Han Cheng, Shin Huei Liu, An Khanh Nu Ton, Chheng Chhay, Pei Heng Kao, Wei Tso ChenChu Yu Hsu, Steven Kim, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Introduction: The presence of bipolar low-voltage zone (LVZ) is a predictor of AF recurrence after PV isolation (PVI). However, changes of wavefront and bipole directions may cause different electrogram characteristics. We aimed to investigate whether using omnipolar maximum voltage (Vmax) map derived from high density (HD) Grid mapping catheter could assess LVZ and AF ablation outcome accurately. Methods: Fifty paroxysmal AF patients (27 males, 57.8 ± 9.5 years old) who underwent 3D mapping guided PVI were enrolled. Left atrial voltage mapping during sinus rhythm before ablation was performed. The significant LVZ (<0.5 mV with area > 5 cm2) were defined as sites by omnipolar Vmax, bipolar HD wave map, conventional bipolar electrograms acquired from electrode pairs along to and across to the catheter shaft. The primary end point was the first documented recurrence of any AF during follow-ups. Results: PVI was performed in all patients, and there were 2 patients (4%) who also received additional non-PV triggers ablation. After a follow-up of 11.4 ± 5.4 months, recurrence of AF occurred in 12 patients (24%). The presence of a significant LVZ was less detected by omnipolar Vmax map, compared to HD wave map (24.0% vs. 58.0%, p = 0.001). LVZ detected by omnipolar Vmax map independently predicted the AF recurrence (odds ratio 16.91; 95% CI, 3.17–90.10; p = 0.001). Conclusion: LVZ detected by omnipolar Vmax map accurately predicts the AF recurrence following ablation in paroxysmal AF, compared to conventional bipolar and HD wave maps, suggesting the omnipolar Vmax map can precisely define the atrial substrate property.

Original languageEnglish
Pages (from-to)42-47
Number of pages6
JournalInternational Journal of Cardiology
Volume351
DOIs
StatePublished - 15 Mar 2022

Keywords

  • Atrial fibrillation
  • Low voltage zone
  • Omnipolar technology
  • Pulmonary vein isolation
  • Recurrence
  • Substrate

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