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Is the Abnormal Conduction Zone of the Left Atrium a Precursor to a Low Voltage Area in Patients with Atrial Fibrillation?
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  • Hideyuki Kishima,
  • Takanao Mine,
  • Eiji Fukuhara,
  • Satoshi Takahashi,
  • Masaharu Ishihara
Hideyuki Kishima
Hyogo Ika Daigaku
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Takanao Mine
Hyogo Ika Daigaku
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Eiji Fukuhara
Hyogo Ika Daigaku
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Satoshi Takahashi
Kawasaki Hospital
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Masaharu Ishihara
Hyogo Ika Daigaku
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Abstract

Background: The abnormal conduction zone (ACZ) in the left atrium (LA) has attracted attention as an arrhythmia source in atrial fibrillation (AF). We investigated the hypothesis that the ACZ is related to the low voltage area (LVA) or the LA anatomical contact areas (CoAs) with other organs. Methods and Results: We studied 100 patients (49 non-paroxysmal AF, 66 males, 67.9±9.9 years) who received catheter ablation for AF. High-density LA mapping during high right atrial pacing was constructed. Isochronal activation maps were created at 5-ms interval setting, and the ACZ was identified on the activation map by locating a site with isochronal crowding of ≥3 isochrones, which are calculated as ≤27 cm/s. The LVA was defined as the following; mild (<1.3 mV), moderate (<1.0 mV), and severe LVA (<0.5 mV). The CoAs (ascending aorta-anterior LA, descending aorta-posterior LA, and vertebrae-posterior LA) were assessed using computed tomography. The ACZ was linearly distributed, and observed in 95 patients (95%). The ACZ was most frequently observed in the anterior wall region (77%). A longer ACZ was significantly associated with a larger LA size and a prevalence of non-PAF. The 51.2±36.2% of ACZ overlapped with mild LVA, 32.9±32.8% of ACZ with moderate LVA, and 14.6±22.0% of ACZ with severe LVA. In contrast, only 25.6±28.0 % of ACZ matched with the CoAs. Conclusion: The abnormal conduction zone reflects LA electrical remodeling and may be a precursor finding of the low voltage zone and not the LA contact areas in patients with atrial fibrillation.

Peer review status:ACCEPTED

29 Jul 2020Submitted to Journal of Cardiovascular Electrophysiology
29 Jul 2020Submission Checks Completed
29 Jul 2020Assigned to Editor
01 Aug 2020Reviewer(s) Assigned
11 Aug 2020Review(s) Completed, Editorial Evaluation Pending
11 Aug 2020Editorial Decision: Revise Minor
26 Aug 20201st Revision Received
26 Aug 2020Assigned to Editor
26 Aug 2020Submission Checks Completed
26 Aug 2020Reviewer(s) Assigned
04 Sep 2020Review(s) Completed, Editorial Evaluation Pending
08 Sep 2020Editorial Decision: Revise Minor
09 Sep 20202nd Revision Received
10 Sep 2020Submission Checks Completed
10 Sep 2020Assigned to Editor
10 Sep 2020Reviewer(s) Assigned
14 Sep 2020Review(s) Completed, Editorial Evaluation Pending
14 Sep 2020Editorial Decision: Accept