PMID- 25064249
OWN - NLM
STAT- MEDLINE
DCOM- 20150806
LR  - 20161222
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
VI  - 11
IP  - 11
DP  - 2014 Nov
TI  - Voltage mapping for delineating inexcitable dense scar in patients undergoing 
      atrial fibrillation ablation: a new end point for enhancing pulmonary vein 
      isolation.
PG  - 1904-11
LID - S1547-5271(14)00800-5 [pii]
LID - 10.1016/j.hrthm.2014.07.027 [doi]
AB  - BACKGROUND: Characterization of left atrial scar using bipolar voltage (BiV) 
      mapping is not well defined. We have previously shown that the BiV range of 
      0.2-0.45 mV can identify chronic scar from prior pulmonary vein isolation (PVI). 
      OBJECTIVE: This study sought to determine a BiV range that can identify atrial 
      inexcitable dense scar (IDS) in patients acutely and chronically after PVI. 
      METHODS: Thirty consecutive patients undergoing first time (n = 15) or redo (n = 
      15) PVI were included. A left atrial shell was created using electroanatomic 
      mapping, and IDS was defined by inability to capture at an output of 10 mA and a 
      pulse width of 2 ms in sinus rhythm, circumferentially at the edge of PVI-related 
      scar (</=5 mm). At each pacing site, BiV amplitude and atrial capture were 
      recorded. RESULTS: Overall, 837 pacing sites were assessed. BiV predicted IDS 
      (receiver operating characteristic curve area 0.93 for first time PVI and 0.90 
      for redo PVI). In first time PVI, the best BiV value to predict IDS was 0.45 mV 
      for the left pulmonary vein-left atrial appendage (LAA-LPV) ridge (sensitivity 
      0.98; specificity 1.0) and 0.2 mV for other localizations (sensitivity 0.91; 
      specificity 0.86). In redo PVI, the best BiV value to predict IDS was 0.2 mV for 
      the LAA-LPV ridge (sensitivity 0.77; specificity 1.0) and 0.15 mV for other 
      localizations (sensitivity 0.81; specificity 0.82). CONCLUSION: BiV reproducibly 
      identifies acute and chronic IDS using a cutoff value of 0.2 mV (0.45 mV for the 
      LAA-LPV ridge) in patients undergoing first time PVI and 0.15 mV (0.2 mV for the 
      LAA-LPV ridge) in patients undergoing redo PVI. IDS thus identified may be a 
      rigorous tool for validating PVI.
CI  - Published by Elsevier Inc.
FAU - Squara, Fabien
AU  - Squara F
AD  - Department of Cardiology, Pasteur University Hospital, Nice, France.
FAU - Frankel, David S
AU  - Frankel DS
AD  - Electrophysiology Section, Cardiovascular Division, Hospital of the University of 
      Pennsylvania, Philadelphia, Pennsylvania.
FAU - Schaller, Robert
AU  - Schaller R
AD  - Electrophysiology Section, Cardiovascular Division, Hospital of the University of 
      Pennsylvania, Philadelphia, Pennsylvania.
FAU - Kapa, Suraj
AU  - Kapa S
AD  - Electrophysiology Section, Cardiovascular Division, Hospital of the University of 
      Pennsylvania, Philadelphia, Pennsylvania.
FAU - Chik, William W
AU  - Chik WW
AD  - Electrophysiology Section, Cardiovascular Division, Hospital of the University of 
      Pennsylvania, Philadelphia, Pennsylvania.
FAU - Callans, David J
AU  - Callans DJ
AD  - Electrophysiology Section, Cardiovascular Division, Hospital of the University of 
      Pennsylvania, Philadelphia, Pennsylvania.
FAU - Marchlinski, Francis E
AU  - Marchlinski FE
AD  - Electrophysiology Section, Cardiovascular Division, Hospital of the University of 
      Pennsylvania, Philadelphia, Pennsylvania.
FAU - Dixit, Sanjay
AU  - Dixit S
AD  - Electrophysiology Section, Cardiovascular Division, Hospital of the University of 
      Pennsylvania, Philadelphia, Pennsylvania. Electronic address: 
      Sanjay.Dixit@uphs.upenn.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140723
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
MH  - Atrial Fibrillation/*physiopathology/*surgery
MH  - Catheter Ablation/*methods
MH  - Cicatrix/*physiopathology
MH  - Comorbidity
MH  - Electrophysiologic Techniques, Cardiac/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Pulmonary Veins/*physiopathology/*surgery
MH  - Reoperation
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
OTO - NOTNLM
OT  - Ablation
OT  - Atrial fibrillation
OT  - Electroanatomic mapping
OT  - Scar
EDAT- 2014/07/30 06:00
MHDA- 2015/08/08 06:00
CRDT- 2014/07/28 06:00
PHST- 2014/05/26 00:00 [received]
PHST- 2014/07/28 06:00 [entrez]
PHST- 2014/07/30 06:00 [pubmed]
PHST- 2015/08/08 06:00 [medline]
AID - S1547-5271(14)00800-5 [pii]
AID - 10.1016/j.hrthm.2014.07.027 [doi]
PST - ppublish
SO  - Heart Rhythm. 2014 Nov;11(11):1904-11. doi: 10.1016/j.hrthm.2014.07.027. Epub 
      2014 Jul 23.