The Relationship Between Endocardial Voltage and Regional Volume in Electroanatomical Remodeled Left Atria in Patients with Atrial Fibrillation: Comparison of Three-Dimensional Computed Tomographic Images and Voltage Mapping.

PARK, JAE HYUNG; PAK, HUI‐NAM; CHOI, EUN JEOUNG; JANG, JIN KUN; KIM, SOOK KYOUNG; CHOI, DONG HOON; CHOI, JONG IL; HWANG, CHUN; KIM, YOUNG‐HOON

Background: Long-standing atrial fibrillation (AF) changes left atrial (LA) morphology, and the LA size is related to recurrence after radiofrequency catheter ablation (RFCA). We hypothesize that LA morphology, based on embryological origin, affects the outcome of RFCA. Methods: We analyzed 3D computed tomographic (CT) images of LA in 70 patients with AF (54 males, 55.6 ± 10.5 years old, paroxysmal AF (PAF):persistent AF (PeAF) = 32:38) who underwent RFCA. Each LA image was divided into venous atrium (VA), anterior LA (ALA), LA appendage (LAA), and both antrum. Absolute and relative volumes were calculated, and the lengths of linear ablation sites were measured. Results: (1) In patients with the mean LA voltage ≤ 2.0 mV, LA volume, especially ALA, was larger (P 2.0 mV. (2) The total LA volume was significantly larger (P < 0.01) and LAA voltages (P < 0.05) and conduction velocities (P < 0.05) were lower in patients with PeAF than in those with PAF. (3) In patients with recurrence, LA volume was generally larger (P < 0.01) than in those without recurrence. In PAF patients with recurrence, the relative volume of ALA was significantly larger (P < 0.01) than those without recurrence. Conclusions Morphologically remodeled LA has low endocardial voltage, and enlargement of ALA is more significant in electroanatomically remodeled LA. The disproportional enlargement of ALA was observed more often in PAF patients with recurrence after ablation than those without recurrence.

ATRIAL fibrillation; CARDIAC surgery; COMPARATIVE studies; HEART disease relapse; RADIO frequency; CATHETER ablation; HEART dilatation

Journal of Cardiovascular Electrophysiology, 2009, Vol 20, Issue 12, p1349

1045-3873

Academic Journal

10.1111/j.1540-8167.2009.01557.x