Relationship Between dominant-frequencies/rotors and Low-voltage Areas
Using an Advisor HD Grid Mapping Catheter after Pulmonary Vein Isolation
of Non-paroxysmal Atrial Fibrillation
Abstract
Background This study aimed to evaluate the relationship between
dominant frequencies (DFs)/rotors and low-voltage areas (LVAs) using the
Advisor HD grid (HDG) after pulmonary vein isolation (PVI) in
non-paroxysmal atrial fibrillation (AF). Methods A total of 73
non-paroxysmal AF patients were prospectively investigated. After
pulmonary vein isolation (PVI), an online real-time phase mapping system
was used to detect the location of rotors with critical non-passively
activated ratios (%NPs) of≧50% in each LA segment, and high-DFs of
≧7Hz were simultaneously mapped. After recovering sinus rhythm, LVAs
(<0.5mV) were mapped using the HDG. Results Sixty-eight of 73
(93.2%) AF patients had minimum to mild LVAs (<10%)
regardless of an enlarged LAD and LA volume (45±6.1mm and 142±30ml).
There were no significant differences in the max and mean DF values and
%NPs between the patients with and without recurrent AF/AT (atrial
tachycardia). However, LVAs were significantly greater in the patients
with AF/AT than in those without (6.4±8.0% vs. 2.5±2.6% P=0.003).
Furthermore, the number of high-DF sites overlapping with LVAs was
significantly greater in the patients with AF/AT than in those without
(0.5±0.8 vs. 0.2±0.7, P=0.019). The AF/AT freedom off anti-arrhythmic
drugs after the PVI was significantly lower in the patients with
high-DFs sites overlapping with LVAs than in those without during
11.6±0.8 months of follow-up (35.7% vs. 69.5%, p=0.021). Conclusions
High-DF sites overlapping with LVAs detected accurately by the HDG,
regardless of whether a minimum to mild extent, might be more selective
targets after a PVI in non-paroxysmal AF patients.