Association of low-voltage areas with the regional wall deformation and the left atrial shape in patients with atrial fibrillation: A proof of concept study



Document Type

Journal Article

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Publication Title

International journal of cardiology. Heart & vasculature



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AF, atrial fibrillation, AR, average radius, ASI, asymmetry index, Atrial fibrillation, Atrial remodeling, CA, catheter ablation, CT, computed tomography, Computer tomography, IQR, inter-quartile range, LA, left atrium, LA-A, left atrial anterior (LA-A) partial volume, LA-P, left atrial posterior (LA-P) partial volume, LAA, left atrial appendage, LAV, left atrial volume with anterior (LA-A) and posterior (LA-P) partial volumes, LV, left ventricle, LV-EF, left ventricular ejection fraction, LVA, low-voltage area, LVDD, left ventricular diastolic dysfunction, MRI, magnetic resonance imaging, PVI, pulmonary vein isolation, S, mean deviation, SD, standard deviation, Sphericity, Voltage mapping


Background: Left atrium (LA) remodeling is associated with atrial fibrillation (AF) and reduced success after AF ablation, but its relation with low-voltage areas (LVA) is not known. This study aimed to evaluate the relation between regional LA changes and LVAs in AF patients. Methods: Pre-interventional CT data of patients (n = 24) with LA-LVA ( < 0.5 mV) in voltage mapping after AF ablation were analyzed (Surgery Explorer, QuantMD LLC). To quantify asymmetry (ASI = LA-A/LAV) a cutting plane parallel to the rear wall and along the pulmonary veins divided the LA-volume (LAV) into anterior (LA-A) and posterior parts. To quantify sphericity (LAS = 1-R/S), a patient-specific best-fit LA sphere was created. The average radius (R) and the mean deviation (S) from this sphere were calculated. The average local deviation (D) was measured for the roof, posterior, septum, inferior septum, inferior-posterior and lateral walls. Results: The roof, posterior and septal regions had negative local deviations. There was a correlation between roof and septum (r = 0.42, p = 0.04), lateral and inferior-posterior (r = 0.48, p = 0.02) as well as posterior and inferior-septal deviations (r = -0.41, p = 0.046). ASI correlated with septum deformation (r = -0.43, p = 0.04). LAS correlated with dilatation (LAV, r = 0.49, p = 0.02), roof (r = 0.52, p = 0.009) and posterior deformation (r = -0.56, p = 0.005). Extended LVA correlated with local deformation of all LA walls, except the roof and the septum. LVA association with LAV, ASI and LAS did not reach statistical significance. Conclusion: Extended LVA correlates with local wall deformations better than other remodeling surrogates. Therefore, their calculation could help predict LVA presence and deserve further evaluation in clinical studies.

Open Access