Pacing cycle length–dependent electrophysiologic changes in left atrium: Poor validity of using low-voltage area and slow conduction area under specific pacing cycle length as absolute substrates of atrial fibrillation

Sekihara, Takayuki; Oka, Takafumi; Ozu, Kentaro; Yoshida, Akira; Sakata, Yasushi

doi:https://doi.org/10.1016/j.hrthm.2024.09.034

Pacing cycle length–dependent electrophysiologic changes in left atrium: Poor validity of using low-voltage area and slow conduction area under specific pacing cycle length as absolute substrates of atrial fibrillation

Sekihara, Takayuki; Oka, Takafumi; Ozu, Kentaro et al.

Heart Rhythm, 2025, 22(7), 1659-1666

アクセス数:16件（2025-09-10 07:36 集計）

固定URL: https://hdl.handle.net/11094/102653

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タイトル	Pacing cycle length–dependent electrophysiologic changes in left atrium: Poor validity of using low-voltage area and slow conduction area under specific pacing cycle length as absolute substrates of atrial fibrillation
著者	researchmap permalink javelin javelin ORCID 0000-0001-9191-7153 0000-0001-9191-7153 Scopus Author ID 56754941100 56754941100 著者名 Sekihara, Takayuki
	NRID 1000030647285 1000030647285 researchmap permalink Takafumioka0410 Takafumioka0410 Scopus Author ID 8712739400 8712739400 著者名 Oka, Takafumi
	NRID 1000010650088 1000010650088 researchmap permalink ozu_cardiology ozu_cardiology Scopus Author ID 55584323100 55584323100 著者名 Ozu, Kentaro
	著者名 Yoshida, Akira
	NRID 1000000397671 1000000397671 ORCID 0000-0002-5618-4721 0000-0002-5618-4721 researchmap permalink C4589 C4589 Scopus Author ID 35395964700 35395964700 著者名 Sakata, Yasushi
キーワード等	Atrial fibrillation
	High-resolution mapping
	Left atrium
	Low-voltage area
	Pacing cycle length dependency
	Wave propagation velocity
内容	Sekihara T., Oka T., Ozu K., et al. Pacing cycle length–dependent electrophysiologic changes in left atrium: Poor validity of using low-voltage area and slow conduction area under specific pacing cycle length as absolute substrates of atrial fibrillation. Heart Rhythm 22, 1659 (2025); https://doi.org/10.1016/j.hrthm.2024.09.034.
抄録	Background: Pacing cycle length (PCL)–dependent changes in left atrial (LA) electrophysiologic properties have not been fully elucidated. Objective: We aimed to elucidate these changes using a high-resolution mapping system. Methods: Forty-eight patients underwent atrial fibrillation ablation with RHYTHMIA HDx. Paired LA maps under a baseline PCL (600 ms) and rapid PCL (300 ms) were acquired after pulmonary vein isolation under right atrial appendage pacing. The PCL-dependent change in the low-voltage area (LVA; area with <0.5 mV bipolar voltage), LA activation time (interval from first LA activation to wavefront collision at lateral wall), regional mean voltage, regional mean wave propagation velocity, and slow conduction area (area with <0.3 m/s wave propagation velocity) were quantitatively analyzed. Results: Under the rapid PCL, the total LVA was significantly increased (7.6 ± 9.5 cm2 vs 6.7 ± 7.6 cm2; P =.031), especially in patients with a 10 cm2 LVA on the baseline PCL map (21.5 ± 9.1 cm2 vs 18.1 ± 6.5 cm2; P =.013). The LA activation time was also prolonged (87.9 ± 16.2 ms vs 84.0 ± 14.0 ms; P <.0001). Although the rapid PCL did not decrease the regional mean voltage, it significantly decreased the regional mean wave propagation velocity and increased the slow conduction area in all measured regions. Conclusion: LVA and slow conduction area can be emphasized by rapid PCL LA mapping. There may be poor validity in using these areas as absolute atrial fibrillation substrates without considering the PCL-dependent changes.
出版者	Elsevier B.V.
収録物名	Heart Rhythm
巻(号)	22(7)
ページ	1659-1666
刊行年月	2025-07-01
言語	英語
ハンドルURL	https://hdl.handle.net/11094/102653
PISSN	15475271
eISSN	15563871
関連情報 (isIdenticalTo)	DOI (出版社版) https://doi.org/10.1016/j.hrthm.2024.09.034
アクセス権	open access
権利情報	This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
出版タイプ	Version of Record
カテゴリ	学術雑誌論文 Journal Article

資源タイプ	学術雑誌論文
ローカル資源タイプ	学術雑誌論文
DCMI資源タイプ	text
DCTERMS.bibliographicCitation	Heart Rhythm. 2025, 22(7), p. 1659-1666
DC.title	Pacing cycle length–dependent electrophysiologic changes in left atrium: Poor validity of using low-voltage area and slow conduction area under specific pacing cycle length as absolute substrates of atrial fibrillation
DC.creator	Sekihara, Takayuki
	Oka, Takafumi
	Ozu, Kentaro
	Yoshida, Akira
	Sakata, Yasushi
DC.publisher	Elsevier B.V.
DC.language' scheme='DCTERMS.RFC1766	英語
DC.type' scheme='DCTERMS.DCMIType	text
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2025-07-01
DC.identifier	https://doi.org/10.1016/j.hrthm.2024.09.034
DC.subject	Atrial fibrillation
	High-resolution mapping
	Left atrium
	Low-voltage area
	Pacing cycle length dependency
	Wave propagation velocity
DC.description	Sekihara T., Oka T., Ozu K., et al. Pacing cycle length–dependent electrophysiologic changes in left atrium: Poor validity of using low-voltage area and slow conduction area under specific pacing cycle length as absolute substrates of atrial fibrillation. Heart Rhythm 22, 1659 (2025); https://doi.org/10.1016/j.hrthm.2024.09.034.
DCTERMS.abstract	Background: Pacing cycle length (PCL)–dependent changes in left atrial (LA) electrophysiologic properties have not been fully elucidated. Objective: We aimed to elucidate these changes using a high-resolution mapping system. Methods: Forty-eight patients underwent atrial fibrillation ablation with RHYTHMIA HDx. Paired LA maps under a baseline PCL (600 ms) and rapid PCL (300 ms) were acquired after pulmonary vein isolation under right atrial appendage pacing. The PCL-dependent change in the low-voltage area (LVA; area with <0.5 mV bipolar voltage), LA activation time (interval from first LA activation to wavefront collision at lateral wall), regional mean voltage, regional mean wave propagation velocity, and slow conduction area (area with <0.3 m/s wave propagation velocity) were quantitatively analyzed. Results: Under the rapid PCL, the total LVA was significantly increased (7.6 ± 9.5 cm2 vs 6.7 ± 7.6 cm2; P =.031), especially in patients with a 10 cm2 LVA on the baseline PCL map (21.5 ± 9.1 cm2 vs 18.1 ± 6.5 cm2; P =.013). The LA activation time was also prolonged (87.9 ± 16.2 ms vs 84.0 ± 14.0 ms; P <.0001). Although the rapid PCL did not decrease the regional mean voltage, it significantly decreased the regional mean wave propagation velocity and increased the slow conduction area in all measured regions. Conclusion: LVA and slow conduction area can be emphasized by rapid PCL LA mapping. There may be poor validity in using these areas as absolute atrial fibrillation substrates without considering the PCL-dependent changes.
DC.rights	This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
DC.format	102653
citation_title	Pacing cycle length–dependent electrophysiologic changes in left atrium: Poor validity of using low-voltage area and slow conduction area under specific pacing cycle length as absolute substrates of atrial fibrillation
citation_author	Sekihara, Takayuki
	Oka, Takafumi
	Ozu, Kentaro
	Yoshida, Akira
	Sakata, Yasushi
citation_publisher	Elsevier B.V.
citation_language	英語
citation_date	2025-07-01
citation_journal_title	Heart Rhythm
citation_volume	22
citation_issue	7
citation_firstpage	1659
citation_lastpage	1666
citation_doi	https://doi.org/10.1016/j.hrthm.2024.09.034
citation_public_url	https://hdl.handle.net/11094/102653

Pacing cycle length–dependent electrophysiologic changes in left atrium: Poor validity of using low-voltage area and slow conduction area under specific pacing cycle length as absolute substrates of atrial fibrillation

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