Tailored Atrial Substrate Modification Based on Low-Voltage Areas in Catheter Ablation of Atrial Fibrillation

DOI Web Site 29 Citations
  • Sascha Rolf
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Simon Kircher
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Arash Arya
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Charlotte Eitel
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Philipp Sommer
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Sergio Richter
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Thomas Gaspar
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Andreas Bollmann
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • David Altmann
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Carlos Piedra
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Gerhard Hindricks
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).
  • Christopher Piorkowski
    From the Department of Electrophysiology, University of Leipzig—Heart Center, Leipzig, Germany (S.R., S.K., A.A., C.E., P.S., S.R., A.B., C.P., G.H.); Department of Electrophysiology, University of Dresden—Heart Center, Dresden, Germany (T.G., C.P.); and Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland (D.A.).

Abstract

<jats:sec> <jats:title>Background—</jats:title> <jats:p>Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a novel individualized approach for catheter ablation of atrial fibrillation (AF) based on low-voltage areas (LVAs) in the left atrium (LA). We sought to assess (1) the incidence of LVAs in patients undergoing AF catheter ablation, (2) the distribution of LVAs within the LA, and (3) the effect of an individualized ablation strategy on long-term rhythm outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> In 178 patients with paroxysmal or persistent AF, LA voltage maps were created during sinus rhythm after circumferential pulmonary vein isolation. Subsequent substrate modification was confined to the presence of LVA (<0.5 mV) and inducible regular atrial tachycardias. LVAs were identified in 35% and 10% of patients with persistent and paroxysmal AF, respectively. The LA roof and the anterior, septal, and posterior wall LA were most often affected. The 12-month atrial tachycardias/AF-free survival was 62% for patients without LVAs and 70% for patients with LVAs and tailored substrate modification ( <jats:italic>P</jats:italic> =0.3). Success rate in a comparison group of 26 LVA patients without further substrate modification was 27%. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>LVAs can be found at preferred sites in 10% of patients with paroxysmal AF and in 35% of patients with persistent AF. This is the first clinical report describing a consistent voltage-based approach for substrate modification in addition to circumferential pulmonary vein isolation irrespective of AF type. Application of this limited individualized approach may have the potential to compensate for the impaired 12-month outcome of patients with endocardial structural defects.</jats:p> </jats:sec>

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