IMR Press / RCM / Volume 24 / Issue 11 / DOI: 10.31083/j.rcm2411329
Open Access Original Research
Impact of Low Voltage Threshold Adjustment on Activation Mapping Interpretation for Atrial Tachycardia in Low-Voltage Left Atrium
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1 Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 200003 Shanghai, China
2 Department of Cardiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 201399 Shanghai, China
*Correspondence: heben@shchest.org (Ben He); zhaoliang80112@126.com (Liang Zhao)
These authors contributed equally.
Rev. Cardiovasc. Med. 2023, 24(11), 329; https://doi.org/10.31083/j.rcm2411329
Submitted: 8 May 2023 | Revised: 23 July 2023 | Accepted: 7 August 2023 | Published: 24 November 2023
(This article belongs to the Section Clinical Electrophysiology)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: The misinterpretation of activation propagation within low voltage zone (LVZ) can complicate atrial tachycardia (AT) mechanism analysis, especially in patients with remodeled atrial substrate. This study investigated the impact of low voltage threshold adjustment (LVTA) on left atrial (LA) tachycardia activation mapping interpretation. Methods: We identified 55 ATs in 42 patients undergoing catheter ablation for LA tachycardia, with a mean LA voltage of <0.5 mV. Activation mapping of LA or both atria was used to evaluate AT mechanisms before and after LVTA. Patients underwent regular clinic follow-up after the procedure. Results: Comparing activation mapping before and after LVTA revealed four categories: (1) complete change in AT circuit and ablation design in 9 ATs; (2) an unchanged AT circuit but tailored ablation design in 16 ATs; (3) identification of bystander gaps in 3 ATs; (4) an unchanged AT circuit and ablation design in 27 ATs. Effective ablation, defined as AT termination or circuit change, was obtained in all 9 Type 1 ATs and 15 of 16 Type 2 ATs by targeting the critical area identified by activation mapping after LVTA. After a median follow-up of 16.5 months, the cumulative freedom from AT was 69.3%. Conclusions: In patients with low LA voltage, conduction propagation hidden within LVZ was not uncommon, but is often excluded from activation mapping. LVTA can uncover this subtle conduction propagation with reliable accuracy, improving the veracity of activation mapping, and helping guide subsequent ablation.

Keywords
atrial tachycardia
high-density mapping
low voltage zone
low voltage threshold adjustment
catheter ablation
Funding
81970276/National Natural Science Foundation of China
22YF1442700/Yangfan Project of Shanghai Science and Technology Commission
Figures
Fig. 1.
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