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Correlation of left atrial phasic transport function and arrhythmogenic substrate in patients with atrial fibrillation: cardiac magnetic resonance feature tracking and bipolar voltage mapping

Session Poster Session 1

Speaker Robert Schoenbauer

Event : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : Deformation Imaging
  • Session type : Poster Session

Authors : R Schoenbauer (Wiener Neustadt,AT), J Tomala (Dresden,DE), B Kirstein (Dresden,DE), Y Huo (Dresden,DE), T Gaspar (Dresden,DE), U Richter (Dresden,DE), J Piorkowski (Dresden,DE), MS Schoenbauer (Vienna,AT), L Fiedler (Wiener Neustadt,AT), FX Roithinger (Wiener Neustadt,AT), C Hengstenberg (Vienna,AT), J Mascherbauer (Vienna,AT), S Ulbrich (Dresden,DE), C Piorkowski (Dresden,DE)

R. Schoenbauer1 , J. Tomala2 , B. Kirstein2 , Y. Huo2 , T. Gaspar2 , U. Richter2 , J. Piorkowski2 , M.S. Schoenbauer3 , L. Fiedler1 , F.X. Roithinger1 , C. Hengstenberg4 , J. Mascherbauer4 , S. Ulbrich2 , C. Piorkowski2 , 1Landesklinikum Wiener Neustadt, Cardiology - Wiener Neustadt - Austria , 2Dresden University of Technology, Department of Cardiology, Division of Cardiac Electrophysiology - Dresden - Germany , 3Hietzing Hospital, Cardiology - Vienna - Austria , 4Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology - Vienna - Austria ,

Cardiac Magnetic Resonance: Deformation Imaging

European Heart Journal ( 2019 ) 40 ( Supplement ), 216

Background: Bipolar voltage mapping is a widely accepted approach to identify areas of arrhythmogenic substrate in patients presenting for atrial fibrillation (AF) ablation.

However, until now little is known about the correlation of left atrial (LA) bipolar voltage distribution and LA transport function.

Purpose: To study the impact of LA low voltage zones (LVZ) on LA transport function.

Methods: 107 consecutive patients presenting for ablation of symptomatic AF (34 paroxysmal AF, 73 persistent AF) were prospectively enrolled. Each patient underwent cardiac magnetic resonance imaging (CMR) within 24 hours prior to the ablation procedure. 59 patients were in sinus rhythm (SR) and 48 in AF. LA phasic indexed volumes (LAVi) and ejection fractions were calculated using biplane area length formula. In addition LA phasic strains and strain rates were analyzed using dedicated software (Figure 1A & B).

LA bipolar voltage mapping was performed prior to beginning of ablation in sinus rhythm using a 3-dimensional mapping system and LVZ were defined as areas of bipolar voltage <0.5mV.

Results: LVZ were present in 47 patients (23 in SR). The area of LVZ was 14.6cm2 (5.3–34.0). For patients in AF at the time of CMR only elevated minimal and maximal LAVi (p=0.001 and p=0.002 respectively) but no LA functional parameter was predictive for the occurrence of LVZ. In contrast for patients in SR all LA phasic volumes (endsystolic, pre atrial contraction and enddiastolic LAVi) and LA function parameters (passive, active and total ejection fraction (EF), reservoir, conduit and booster pump strains and strain rates) were predictive for the occurrence of LVZ. After clustered and pooled multivariate logistic regression only impaired booster pump strain rate was still predictive for occurrence of LVZ (OR 0.974, 95% CI 0.950–0.998, p=0.036).

In addition Pearson correlation analysis revealed a strong link between LA booster pump functional parameters and cm2 expansion of LVZ areas: LA active EF, LA booster pump strain and SR (r=−0.42, p=0.044; r=−0.47, p=0.024; r=−0.65, p=0.001 [Figure 1C] respectively).

Conclusion: For patients in SR LA transport function is closely linked to the occurrence of LA LVZ and outperforms LA volumetric measurements for the prediction of LA LVZ.

Furthermore LA booster pump function parameters show robust correlation to the extension of LA LVZ.

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