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A new interpretation of non-pulmonary vein substrates of the left atrium in patients with atrial fibrillation.
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  • Mariano Rillo,
  • Zefferino Palamà,
  • Raffaele Punzi,
  • Salvatore Vitanza,
  • Angelo Aloisio,
  • Silvia Polini,
  • Antonella Tucci,
  • Annalisa Pollastrelli,
  • Francesco Zonno,
  • Antonio Anastasia,
  • Cesare Giannattasio,
  • Luigi My
Mariano Rillo
Casa Di Cura Villa Verde
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Zefferino Palamà
Casa di Cura Villa Verde Srl
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Raffaele Punzi
Casa Di Cura Villa Verde
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Salvatore Vitanza
Casa Di Cura Villa Verde
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Angelo Aloisio
Casa Di Cura Villa Verde
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Silvia Polini
Casa Di Cura Villa Verde
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Antonella Tucci
Casa Di Cura Villa Verde
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Annalisa Pollastrelli
Abbott Medical Italia SpA
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Francesco Zonno
Abbott Medical Italia SpA
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Antonio Anastasia
Casa di Cura Villa Verde Srl
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Cesare Giannattasio
Casa Di Cura Villa Verde
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Luigi My
Casa Di Cura Villa Verde
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Abstract

Background. Substrate analysis of the left atrium in patients undergoing atrial fibrillation ablation has limitations when performed by means of simple bipolar acquisition. Objective. To evaluate the incidence of low-voltages (LV) through maps constructed by means of various catheters:multipoltar (MC), omnipolar (OC) and circular catheters (CMC) with the 3D electro-anatomical systems (3d-S) CARTO3 and Ensite-Precision. Methods. To assess LV we acquired maps by means of CMC and MC in the voltage range 0.05-0.5 mV in 70 patients in sinus rhythm. In case of OC only, we made an intra-patient comparison of bipolar maps constructed in along, across and HD-Wave configurations by means of Ensite-Precision in the ranges of 0.05-0.5 mV and 0.5-1.0 mV. Basing on this comparison, we chose the range that best identified LV and characterized patchy fibrosis by analyzing a set of different colors (qualitative analysis). Finally, we performed a quantitative analysis of LV by applying the qualitative characteristics described above. Results. Basing on our settings, the optimal range for OC was 0.3-0.6 mV. OC revealed smaller LV areas than MC (p <0.05 or p <0.001), except in the lateral wall. No significant differences were observed between CMCs. The same rates of AF recurrence were found for OC and MC during the follow-up period. Conclusions.In our experience, OC does not present the limits of bipolar HD maps, though further studies are needed in order to confirm that 0.3-0.6 mV as LV optimal voltage range.