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Heart Rhythm. 2007 Feb;4(2):138-44. Epub 2006 Oct 20.

Regional left atrial voltage in patients with atrial fibrillation.

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  • 1Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California 94143-1354, USA.

Abstract

BACKGROUND:

Regional differences in fibrosis, particularly related to the posterior wall and septum, may be important in atrial fibrillation (AF). Using electroanatomic mapping, voltage can be used as a measure of fibrosis.

OBJECTIVES:

The purpose of this study was to determine if patients with AF have disproportionately lower voltage in the septal and posterior walls of the left atrium.

METHODS:

Sinus rhythm left atrial electroanatomic maps were used in serial patients presenting for left atrial ablation of AF (8-mm tip). Patients undergoing left atrial mapping for focal atrial tachycardia (AT) were used as a comparison group (4-mm tip). Animal experiments were performed to assess the influence of ablation catheter tip size on voltage amplitude.

RESULTS:

The posterior and septal walls exhibited the lowest voltages in both groups. Compared with the anterior wall, there was a 3.78-fold greater odds of finding a low-voltage point (<0.5 mV) in the septum (P <.001) and a 3.37-fold greater odds of finding a low-voltage point in the posterior wall (P <.001) in the AF patients; the proportion of low-voltage points by region were not significantly different in the AT group. In the animal model, the mean voltage obtained from an 8-mm ablation catheter was significantly higher (0.30 +/- 0.17 mV) than that obtained from the same points using a 4-mm catheter (0.22 +/- 0.17, P = .05).

CONCLUSION:

Regional differences in voltage are present in patients with atrial arrhythmias, with AF patients exhibiting significantly more low-voltage areas in the septum and posterior walls.

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