Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and Termination

Background: Low-voltage zones (LVZs) were usually targeted for ablation in atrial fibrillation (AF). However, its relationship with AF initiation, perpetuation, and termination remains to be studied. This study aimed to explore such relationships.Methods: A total of 126 consecutive AF patients were...

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Main Authors: Zheng Liu, Yu Xia, Changyan Guo, Xiaofeng Li, Pihua Fang, Xiandong Yin, Xinchun Yang
Format: Article
Language:English
Published: Frontiers Media S.A. 2021-08-01
Series:Frontiers in Cardiovascular Medicine
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fcvm.2021.705510/full
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spelling doaj-2cad5a63f24c44dcac147d27d7cd043c2021-08-02T05:06:10ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-08-01810.3389/fcvm.2021.705510705510Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and TerminationZheng Liu0Yu Xia1Changyan Guo2Xiaofeng Li3Pihua Fang4Xiandong Yin5Xinchun Yang6Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, ChinaState Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Cardiology, Xilin Gol League Central Hospital, Inner Mongolia, Xilinhot, ChinaState Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaState Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaHeart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, ChinaHeart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, ChinaBackground: Low-voltage zones (LVZs) were usually targeted for ablation in atrial fibrillation (AF). However, its relationship with AF initiation, perpetuation, and termination remains to be studied. This study aimed to explore such relationships.Methods: A total of 126 consecutive AF patients were enrolled, including 71 patients for AF induction protocol and 55 patients for AF termination protocol. Inducible and sustainable AF were defined as induced AF lasting over 30 and 300 s, respectively. Terminable AF was defined as those that could be terminated into sinus rhythm within 1 h after ibutilide administration. Voltage mapping was performed in sinus rhythm for all patients. LVZ was quantified as the percentage of the LVZ area (LVZ%) to the left atrium surface area.Results: The rates of inducible, sustainable, and terminable AF were 29.6, 18.3, and 38.2%, respectively. Inducible AF patients had no significant difference in overall LVZ% compared with uninducible AF patients (10.2 ± 11.8 vs. 8.5 ± 12.6, p = 0.606), while sustainable and interminable AF patients had larger overall LVZ% than unsustainable (16.2 ± 11.5 vs. 0.5 ± 0.7, p < 0.001) and terminable AF patients (44.6 ± 26.4 vs. 26.3 ± 22.3, p < 0.05), respectively. The segmental LVZ distribution pattern was diverse in the different stages of AF. Segmental LVZ% difference was initially observed in the anterior wall for patients with inducible AF, and the septum was further affected in those with sustainable AF, and the roof, posterior wall, and floor were finally affected in those with interminable AF.Conclusions: The associations between LVZ with AF initiation, perpetuation, and termination were different depending on its size and distribution.https://www.frontiersin.org/articles/10.3389/fcvm.2021.705510/fullatrial fibrillationelectroanatomic mappinglow voltageinducibilitysustainabilitytermination
collection DOAJ
language English
format Article
sources DOAJ
author Zheng Liu
Yu Xia
Changyan Guo
Xiaofeng Li
Pihua Fang
Xiandong Yin
Xinchun Yang
spellingShingle Zheng Liu
Yu Xia
Changyan Guo
Xiaofeng Li
Pihua Fang
Xiandong Yin
Xinchun Yang
Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and Termination
Frontiers in Cardiovascular Medicine
atrial fibrillation
electroanatomic mapping
low voltage
inducibility
sustainability
termination
author_facet Zheng Liu
Yu Xia
Changyan Guo
Xiaofeng Li
Pihua Fang
Xiandong Yin
Xinchun Yang
author_sort Zheng Liu
title Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and Termination
title_short Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and Termination
title_full Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and Termination
title_fullStr Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and Termination
title_full_unstemmed Low-Voltage Zones as the Atrial Fibrillation Substrates: Relationship With Initiation, Perpetuation, and Termination
title_sort low-voltage zones as the atrial fibrillation substrates: relationship with initiation, perpetuation, and termination
publisher Frontiers Media S.A.
series Frontiers in Cardiovascular Medicine
issn 2297-055X
publishDate 2021-08-01
description Background: Low-voltage zones (LVZs) were usually targeted for ablation in atrial fibrillation (AF). However, its relationship with AF initiation, perpetuation, and termination remains to be studied. This study aimed to explore such relationships.Methods: A total of 126 consecutive AF patients were enrolled, including 71 patients for AF induction protocol and 55 patients for AF termination protocol. Inducible and sustainable AF were defined as induced AF lasting over 30 and 300 s, respectively. Terminable AF was defined as those that could be terminated into sinus rhythm within 1 h after ibutilide administration. Voltage mapping was performed in sinus rhythm for all patients. LVZ was quantified as the percentage of the LVZ area (LVZ%) to the left atrium surface area.Results: The rates of inducible, sustainable, and terminable AF were 29.6, 18.3, and 38.2%, respectively. Inducible AF patients had no significant difference in overall LVZ% compared with uninducible AF patients (10.2 ± 11.8 vs. 8.5 ± 12.6, p = 0.606), while sustainable and interminable AF patients had larger overall LVZ% than unsustainable (16.2 ± 11.5 vs. 0.5 ± 0.7, p < 0.001) and terminable AF patients (44.6 ± 26.4 vs. 26.3 ± 22.3, p < 0.05), respectively. The segmental LVZ distribution pattern was diverse in the different stages of AF. Segmental LVZ% difference was initially observed in the anterior wall for patients with inducible AF, and the septum was further affected in those with sustainable AF, and the roof, posterior wall, and floor were finally affected in those with interminable AF.Conclusions: The associations between LVZ with AF initiation, perpetuation, and termination were different depending on its size and distribution.
topic atrial fibrillation
electroanatomic mapping
low voltage
inducibility
sustainability
termination
url https://www.frontiersin.org/articles/10.3389/fcvm.2021.705510/full
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