The relative voltage index: a novel tailored method to identify left atrial low voltage areas in non-paroxysmal AF.

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Frontiers in Cardiovascular Medicine Pub Date : 2025-09-16 eCollection Date: 2025-01-01 DOI:10.3389/fcvm.2025.1656983

Guoshu Yang, Shiqiang Xiong, Yan Luo, Duan Luo, Michael Shehata, Zhen Zhang, Lin Cai, Xunzhang Wang, Ashkan Ehdaie, Hanxiong Liu

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Abstract

Background: The optimal voltage threshold for determining low voltage areas (LVA) in non-paroxysmal atrial fibrillation (NPAF) is unclear. This study aims to evaluate a patient-specific voltage measurement using the left atrial appendage (LAA) as a benchmark to establish a normalized threshold for detecting LVA in NPAF.

Methods: Bipolar LA and LAA voltage in 40 NPAF and 42 patients with no AF (control group) were studied in sinus rhythm (SR) and AF (NPAF group) and SR only in the control group. Bipolar LA and LAA voltage distribution were compared between the NPAF and control groups. Fibrotic regions identified by late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) was used as the reference standard comparison in the NPAF group.

Results: The median, 5th percentile (V_LA5%), and the 95th percentile of bipolar voltage in the LA were significantly lower in NPAF patients than controls. No significant LAA voltage differences between groups [median = 3.303 (1.796) vs. 3.100 (1.045); V_LAA95% = 8.089 (3.571) vs. 7.604 (3.404), all p > 0.05]. A strong linear correlation between V_LA5% and V_LAA95% was observed in the control group. The standardized relative voltage index (RVI) factor of 0.1324 was identified as the threshold for defining LVA and calculated as V_LA5% = 0.1324 × V_LAA95%. The correlation between LVA guided by RVI was superior to the universal threshold for detecting LVA in sinus and AF rhythms using LGE-MRI as the gold standard.

Conclusion: A patient-tailored low voltage threshold can be obtained using a simplified equation and provides more accurate representation of LVA in NPAF than universal thresholds.

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相对电压指数：一种识别非阵发性房颤左房低压区的新方法。

背景：确定非阵发性心房颤动（NPAF）低压区（LVA）的最佳电压阈值尚不清楚。本研究旨在评估以左心房附件（LAA）为基准的患者特异性电压测量，以建立NPAF中LVA检测的归一化阈值。方法：对40例NPAF患者和42例无房颤患者（对照组）的双极LA和LAA电压进行窦性心律（SR）和房颤（NPAF组）和对照组（SR组）的研究。比较NPAF组和对照组的双极LA和LAA电压分布。晚期钆增强磁共振成像（LGE-MRI）鉴定的纤维化区域作为NPAF组的参考标准对照。结果：NPAF患者LA双极电压中位数、第5百分位（VLA5%）和第95百分位显著低于对照组。各组间LAA电压无显著差异[中位数= 3.303 (1.796)vs. 3.100 (1.045)；VLAA95% = 8.089(3.571)和7.604 (3.404),p > 0.05)。在对照组中，VLA5%和VLAA95%之间存在很强的线性相关。将标准化相对电压指数（RVI）因子0.1324作为定义LVA的阈值，计算为VLA5% = 0.1324 × VLAA95%。RVI引导下LVA的相关性优于以LGE-MRI为金标准检测窦内LVA的通用阈值。结论：采用简化方程可获得适合患者的低压阈值，该阈值比通用阈值更准确地表示NPAF的LVA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Cardiovascular Medicine Medicine-Cardiology and Cardiovascular Medicine

CiteScore

3.80

自引率

11.10%

发文量

3529

审稿时长

14 weeks

期刊介绍： Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers? At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.