Algorithm for determining the fibrosis stage using high-density mapping

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Aims. To develop an algorithm for assessing the stage of fibrosis based on high-density endocardial mapping. To study the effect of the stage of left atrial (LA) fibrosis on the results of atrial fibrillation (AF) catheter ablation. Methods. The study included 64 patients with paroxysmal or persistent AF, who underwent high-density LA mapping and catheter ablation. After the intervention procedure, we analyzed the electroanatomical maps of the left atrium, assessed the prevalence of low-voltage areas according to the developed algorithm. Patients were divided into 4 groups depending on the prevalence of areas of low voltage based on the Utah score. Results. The follow-up period was 14.5 ± 6.7 months. AF recurrence developed in 18 (28.1%) patients after the ablation procedure. AF recurrence after ablation was more frequent in patients with a low-voltage area of more than 20% than in patients with a low-voltage left atrial area of less than 20%, 6 (15.4%) versus 12 (48%), p=0.02. A logistic regression analysis was performed to identify AF recurrence predictors in the postoperative period. As a result, only widespread areas of low-amplitude activity were an independent predictor of AF recurrence after the pulmonary veins isolation, this predictive model was significant (p=0.026). Significant statistical differences between groups I, II and III,I V are the ejection fractions and the duration of the P-wave. Patients with low-voltage regions have lower left ventricular ejection fraction (62.8±6.9% versus 58.1±5.7%, p=0.01), and longer P-wave duration (84.7±8,2 ms versus 101.5±11.0 ms, p=0.01). Conclusion. LA high-density mapping before AF ablation makes it possible to determine the prevalence of low-voltage areas. After regression analysis, it was proved that common low-voltage areas are an independent predictor of AF recurrence after pulmonary vein isolation. Patients with low-voltage areas of more than 20% of the LA surface have longer P-wave duration and lower left ventricular ejection fraction.

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