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J Am Coll Cardiol, 2007; 49:1306-1314, doi:10.1016/j.jacc.2006.11.033 (Published online 8 March 2007).
© 2007 by the American College of Cardiology Foundation
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Effects of Stepwise Ablation of Chronic Atrial Fibrillation on Atrial Electrical and Mechanical Properties

Yoshihide Takahashi, MD*, Mark D. O'Neill, MB, BCh, DPhil, Méléze Hocini, MD, Patricia Reant, MD, Anders Jonsson, MD, Pierre Jaïs, MD, Prashanthan Sanders, MBBS, PhD, Thomas Rostock, MD, Martin Rotter, MD, Frédéric Sacher, MD, Stephane Laffite, MD, PhD, Raymond Roudaut, MD, Jacques Clémenty, MD and Michel Haïssaguerre, MD

Hôpital Cardiologique du Haut-Lévêque, Université Victor Segalen Bordeaux 2, Bordeaux, France


Figure 1
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  		Figure 1 Electroanatomical Mapping of the Right Atrium Displaying Activation Time and Bipolar Voltages

(A) Unicentric pacemaker activity is observed in the midposterior right atrium 28 mm from the junction of the superior vena cava. (B) Purple represents bipolar voltages of ≥0.5 mV.

 

Figure 2
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  		Figure 2 Propagation Map of the Left and Right Atrium During Sinus Rhythm

Earliest activation is the high anterior left atrium, corresponding to the Bachmann bundle insertion (A to D).

 

Figure 3
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  		Figure 3 Activation Map and Bipolar Voltage Map of the LA During Sinus Rhythm in a Patient Who Underwent the Randomized Ablation Strategy

(A) Earliest activation is 30 ms after P-wave onset in the septum (red). Latest activation is after QRS complex in the left atrial (LA) appendage (dark blue), at 325 ms after P-wave onset. (B) Scar or low-voltage area is observed in the anterior LA and septum. Tissue damage in these regions seems to be associated with intra-atrial conduction abnormality. Purple represents bipolar voltages of ≥0.5 mV.

 

Figure 4
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  		Figure 4 Bipolar Voltage Map of Both Atria in an Anteroposterior Projection and a Posteroanterior Projection in a Patient Who Underwent Randomized Ablation Strategy

In the right atrium, there is no scar and 8% of low-voltage area. In contrast, scar is present around the pulmonary veins at the posterior and inferior left atrium, accounting for 44% of the left atrium surface area and low-voltage area is present at the roof, anterior left atrium, septum, and inferior left atrium, accounting for 39% of the left atrium surface area (A and B). Note that bipolar voltages in the left atrial appendage are ≥0.5 mV. This patient showed late diastolic mitral flow of 30 cm/s at 3 months after catheter ablation.

 

Figure 5
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  		Figure 5 Bipolar Voltage Map of the LA in a Patient Who Underwent the Specific Ablation Strategy

(A) Anteroposterior projection; (B) posteroanterior projection. Scar tissue is limited in the pulmonary vein region, accounting for 17% of the left atrial (LA) surface areas. Low-voltage tissue is present in the anterior LA and LA roof, accounting for 5% of the LA surface areas. Purple represents bipolar voltages of ≥0.5 mV.

 

Figure 6
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  		Figure 6 Incidence of Low-Voltage and Scar Tissue in the Left Atrium

LAA = left atrial appendage.

 

Figure 7
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  		Figure 7 Clinical Outcome of the Studied Patients

AF = atrial fibrillation; AT = atrial tachycardia; pt = patient.

 

Figure 8
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  		Figure 8 Doppler Tracing at the Mitral Valve Inflow

Late diastolic mitral flow is shown.

 




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