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- Open Access
Comparison of electroanatomic voltage mapping with late gadolinium enhancement CMR
© Peters et al.; licensee BioMed Central Ltd. 2014
- Published: 16 January 2014
- Late Gadolinium Enhancement
- Pulmonary Vein Isolation
- Late Gadolinium Enhancement Image
- Voltage Mapping
- Pulmonary Vein Ostium
Atrial fibrillation (AF) is associated with atrial remodeling, including atrial cellular pathology [1, 2], left atrial enlargement , and low voltage on electroanatomic mapping (EAM). Recent studies have identified late gadolinium enhancement (LGE) in AF subjects pre-PVI as novel evidence of LA remodeling . One study compared voltage by EAM obtained prior to a pulmonary vein isolation (PVI) procedure with the extent of atrial fibrosis using LGE . Our goal was to further correlate EAM voltages with LGE.
Sixteen AF patients were imaged on a 1.5T scanner (Achieva, Philips Healthcare, NL) using high resolution LGE , prior to their first PVI. Left atrial LGE was obtained using an ECG-triggered, navigator-gated 3D GRE inversion recovery (IR) sequence obtained 10-20 minutes after the administration of 0.2 mmol/kg of Gd-DTPA, with spatial resolution of 1.3 × 1.3 × 4 mm 3. The left atrial cavity and enhanced tissue were segmented on the LGE images, using a threshold corresponding to the signal of enhanced mitral valves. EAM was performed by CARTO (Biosense, Webster, Diamond Bar, CA, USA). The LGE enhancement and EAM data were registered using pulmonary vein ostia as landmarks, and fused. The mean bipolar voltage in regions with LA LGE enhancement vs. no LGE enhancement was calculated. Regions with no voltage mapping data (within 5 mm radius) were excluded. The areas of the LA cavity with low voltage (<0.38 mV) or with LGE were measured.
All (N = 16)
More extensive LGE by area (%)
Less extensive LGE by area (%)
58 ± 11
63 ± 7
51 ± 12
Low voltage area (%)
33 ± 9%
35 ± 9%
29 ± 9%
26 ± 4
26 ± 4
28 ± 3
LA volume index
64 ± 20
62 ± 17
69 ± 23
Comparison of EAM and LGE enhancement/scar shows a relationship by which the voltage measured in enhanced regions of the atrial wall have lower average voltage, and a potential correspondence between LGE and EAM.
Funding: NIH (NHLBI R21 HL 098573 & R21 HL103463).
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