Comparison of electroanatomic voltage mapping with late gadolinium enhancement CMR
Peters et al. Journal of Cardiovascular Magnetic
Resonance
Comparison of electroanatomic voltage mapping with late gadolinium enhancement CMR
Dana C Peters 0 1
Warren J Manning 1 2 3
Mark E Josephson 1 3
James S Duncan 0 1 4
Sudhakar Chelikani 0 1
0 Diagnostic Radiology, Yale School of Medicine , New Haven, Connecticut , USA
1 From 17th Annual SCMR Scientific Sessions New Orleans , LA, USA. 16-19 January 2014
2 Radiology, Beth Israel Deaconess Medical Center , Boston, Massachusetts , USA
3 Cardiovascular Medicine, Beth Israel Deaconess Medical Center , Boston, Massachusetts , USA
4 Biomedical Engineering, Yale University , New Haven, Connecticut , USA
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Background
Atrial fibrillation (AF) is associated with atrial
remodeling, including atrial cellular pathology [1,2], left atrial
enlargement [3], and low voltage on electroanatomic
mapping (EAM)[4]. Recent studies have identified late
gadolinium enhancement (LGE) in AF subjects pre-PVI
as novel evidence of LA remodeling [5]. One study
compared voltage by EAM obtained prior to a pulmonary
vein isolation (PVI) procedure with the extent of atrial
fibrosis using LGE [6]. Our goal was to further correlate
EAM voltages with LGE.
Methods
Sixteen AF patients were imaged on a 1.5T scanner
(Achieva, Philips Healthcare, NL) using high resolution
LGE [7], prior to their first PVI. Left atrial LGE was
obtained using an ECG-triggered, navigator-gated 3D GRE
inversion recovery (IR) sequence obtained 10-20 minutes
after the administration of 0.2 mmol/kg of Gd-DTPA,
with spatial resolution of 1.3 1.3 4 mm 3. The left
atrial cavity and enhanced tissue were segmented on the
LGE images, using a threshold corresponding to the signal
of enhanced mitral valves. EAM was performed by
CARTO (Biosense, Webster, Diamond Bar, CA, USA).
The LGE enhancement and EAM data were registered
using pulmonary vein ostia as landmarks, and fused. The
mean bipolar voltage in regions with LA LGE
enhancement vs. no LGE enhancement was calculated. Regions
with no voltage mapping data (within 5 mm radius) were
excluded. The areas of the LA cavity with low voltage
(<0.38 mV) or with LGE were measured.
Results
Among all subjects, the mean bipolar voltage recorded in
regions with LGE enhancement was 0.29 0.17 mV vs.
0.51 0.25 mV in regions without (p < 0.001). Figure 1A
Figure 1 A) Reconstructed bipolar voltage map merged with LGE enhancement (purple mesh). See voltage scale bar. B) Linear
relationship between low voltage extent and LGE enhancement extent (p = 0.20).
*p = 0.03.
Low voltage area (%)
LA volume index
All (N = 16)
Less extensive LGE by area (%)
shows a representative map of LGE enhancement located
in a region of low voltage. Figure 1B plots extent of low
voltage vs. extent of LGE. Patients with more or less
extensive LGE (using a cutoff of 6% by area) had similar
BMI, LA volumes, hypertension, but older age correlated
with greater LGE (Table 1).
Conclusions
Comparison of EAM and LGE enhancement/scar shows a
relationship by which the voltage measured in enhanced
regions of the atrial wall have lower average voltage, and a
potential correspondence between LGE and EAM.
1. Thiedemann KU , Ferrans VJ : Am J Pathol 1977 , 89 : 575 - 604 . 2. De Oliveira IM , et al: Cardiovasc Pathol 2012 . 3. Vaziri SM : Hypertension 1995 , 25 ( 6 ): 1155 - 60 . 4. Verma A , et al: JACC 2005 , 45 : 285 - 292 . 5. Oakes RS , et al: Circ 2009 , 119 : 1758 - 1767 . 6. Malcome-Lawes LC , et al: Heart Rhythm 2013 , 10 : 1184 - 91 . 7. Peters DC , et al: Radiology 2007 , 243 : 690 - 695 . (...truncated)