High-resolution mapping of reentrant atrial tachycardias: Relevance of low bipolar voltage.

Bipolar voltage is widely used to characterize the atrial substrate but has been poorly validated, particularly during clinical tachycardias. The purpose of this study was to evaluate the diagnostic performance of voltage thresholds for identifying regions of slow conduction during reentrant atrial tachycardias (ATs). Thirty bipolar voltage and activation maps created during reentrant ATs were analyzed to (1) examine the relationship between voltage amplitude and conduction velocity (CV), (2) measure the diagnostic ability of voltage thresholds to predict CV, and (3) identify determinants of AT circuit dimensions. Voltage amplitude was categorized as "normal" (>0.50 mV), "abnormal" (0.05-0.50 mV), or "scar" (<0.05 mV); slow conduction was defined as <30 cm/s. A total of 266,457 corresponding voltage and CV data points were included for analysis. Voltage and CV were moderately correlated (r = 0.407; P < .001). Bipolar voltage predicted regions of slow conduction with an area under the receiver operating characteristic curve of 0.733 (95% confidence interval 0.731-0.735). A threshold of 0.50 mV had 91% sensitivity and 35% specificity for identifying slow conduction, whereas 0.05 mV had 36% sensitivity and 87% specificity, with an optimal voltage threshold of 0.15 mV. Analyses restricted to the AT circuits identified weaker associations between voltage and CV and an optimal voltage threshold of 0.25 mV. Widely used bipolar voltage amplitude thresholds to define "abnormal" and "scar" tissue in the atria are, respectively, sensitive and specific for identifying regions of slow conduction during reentrant ATs. However, overall, the association of voltage with CV is modest. No clinical predictors of AT circuit dimensions were identified. Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Citation

F Daniel Ramirez, Marianna Meo, Corentin Dallet, Philipp Krisai, Konstantinos Vlachos, Antonio Frontera, Masateru Takigawa, Yosuke Nakatani, Takashi Nakashima, Clémentine André, Tsukasa Kamakura, Takamitsu Takagi, Aline Carapezzi, Romain Tixier, Rémi Chauvel, Ghassen Cheniti, Josselin Duchateau, Thomas Pambrun, Frédéric Sacher, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs, Rémi Dubois, Nicolas Derval. High-resolution mapping of reentrant atrial tachycardias: Relevance of low bipolar voltage. Heart rhythm. 2023 Mar;20(3):430-437

Mesh Tags

PMID: 36368515

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