Sinus rhythm voltage fingerprinting in patients with mitral valve disease using a high-density epicardial mapping approach

Europace. 2021 Mar 8;23(3):469-478. doi: 10.1093/europace/euaa336.

Abstract

Aims: Unipolar voltage (UV) mapping is increasingly used for guiding ablative therapy of atrial fibrillation (AF) as unipolar electrograms (U-EGMs) are independent of electrode orientation and atrial wavefront direction. This study was aimed at constructing individual, high-resolution sinus rhythm (SR) UV fingerprints to identify low-voltage areas and study the effect of AF episodes in patients with mitral valve disease (MVD).

Methods and results: Intra-operative epicardial mapping (interelectrode distance 2 mm) of the right and left atrium, Bachmann's bundle (BB), and pulmonary vein area was performed in 67 patients (27 male, 67 ± 11 years) with or without a history of paroxysmal AF (PAF). In all patients, there were considerable regional variations in voltages. UVs at BB were lower in patients with PAF compared with those without [no AF: 4.94 (3.56-5.98) mV, PAF: 3.30 (2.25-4.57) mV, P = 0.006]. A larger number of low-voltage potentials were recorded at BB in the PAF group [no AF: 2.13 (0.52-7.68) %, PAF: 12.86 (3.18-23.59) %, P = 0.001]. In addition, areas with low-voltage potentials were present in all patients, yet we did not find any predilection sites for low-voltage potentials to occur.

Conclusion: Even in SR, advanced atrial remodelling in MVD patients shows marked inter-individual and regional variation. Low UVs are even present during SR in patients without a history of AF indicating that low UVs should carefully be used as target sites for ablative therapy.

Keywords: Atrial fibrillation; Cardiac electrophysiology; High-resolution epicardial mapping; Mitral valve disease; Mitral valve surgery; Sinus rhythm; Voltage mapping.

MeSH terms

  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / surgery
  • Epicardial Mapping
  • Heart Atria
  • Heart Valve Diseases* / complications
  • Heart Valve Diseases* / diagnosis
  • Heart Valve Diseases* / surgery
  • Humans
  • Male
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / surgery