SPC365

Low voltage and low wave speed are rarely present outside the left atrium-pulmonary veins junction in paroxysmal atrial fibrillation but frequently present in persistent forms

Session: Comunicações Orais - Sessão 12 - Fibrilhação Auricular: Novas Perspetivas sobre os Mecanismos
Speaker: Leonor Parreira

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.9 Atrial Fibrillation - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Leonor Parreira; Lia Marques; Rita Marinheiro; Jose Farinha; Dinis Mesquita; Claudia Encarnação; Pedro Amador; Luis Duarte; Maria Joao Lopes; Pedro Contreiras; Duarte Chambel; Rui Caria

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Background and aim:</span></span></strong> <span style="font-size:10.0pt"><span style="color:black">Multielectrode high-density catheters have enabled </span></span></span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">acquisition of </span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="color:black">comprehensive and dense maps of electrogram&rsquo;s amplitude and timing. </span></span><span style="font-size:10.0pt"><span style="color:black">However, </span></span><span style="font-size:10.0pt"><span style="color:black">automated activation and voltage mapping are flawed by catheter orientation in relation to the wavefront activation. Omnipolar mapping technology (OT) uses both unipolar and bipolar signals to obtain OT signals and</span></span><span style="font-size:10.0pt"> increases the accuracy of automatic point acquisition allowing for a high- density map in a quick and efficient way. The aim of this study was to automatically assess with OT, the left atrium (LA) voltage and wave speed propagation map in sinus rhythm (SR) according to the type of atrial fibrillation (AF).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Methods: </span></span></strong><span style="font-size:10.0pt"><span style="color:black">We studied<strong> </strong>12 consecutive patients referred for ablation of AF, either paroxysmal (PAF) (n=6) or persistent (Pers-AF) (n=6) using catheters with OT. Patients with Pers-AF were cardioverted, and a voltage and propagation wave speed map in SR&nbsp;was obtained before ablation in all patients. The cut-off value&nbsp;for low voltage areas (LVAs) was less than 0.1 mV and for low wave speed (LWS) was less than 0.4 mm/ms.&nbsp;&nbsp;Results were compared according to the type of AF.&nbsp; </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Results: </span></span></strong><span style="font-size:10.0pt"><span style="color:black">The results are depicted in the Table. The median duration of AF in Pers-AF was 15 (5-24) months and those patients had a higher CHADSVASC score, but the two groups did not differ regarding&nbsp;other demographic and anatomical evaluated parameters.&nbsp;Patients with Pers-AF displayed presence of LVAs in 100% of cases in comparison with 17% for PAF patients (p=0.015) and the total LVA in cm<sup>2</sup> was also significantly higher, (p=0.002). Also, the number of LWS areas and the total area of LWS were higher in Pers-AF than PAF,( p=0.041 and p= 0.015), &nbsp;and were more frequently located outside the PV-LA junction in Pers-AF than in PAF, p=0.015. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Conclusions: </span></span></strong><span style="font-size:10.0pt"><span style="color:black">Patients with PAF never presented LVAs or LWS outside the PV-LA junction. </span></span></span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">On the contrary, </span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="color:black">patients with Pers-AF have frequently anatomical and electrophysiological abnormalities in the LA body. These findings may suggest the need for a wider ablation strategy in Pers-AF. </span></span></span></span></p>