Structural and functional myocardium changes due to the prevalence of low-amplitude activity in the left atrium according to high-density voltage mapping in patients with atrial fibrillation

Aim. To assess the relationship between structural and functional parameters of the heart and the presence and prevalence of low-amplitude activity (LAA) zones according to high-density voltage mapping of the left atrium (LA) in patients with atrial fibrillation (AF).

Methods. The study included 57 patients (23 women and 34 men) 55.4±9.8 years with paroxysmal (n=40, 70%) and persistent AF (n=17, 30%). Transthoracic echocardiography, assessment of deformation of both atria - 2D Strain STE were performed in all patients. High-density voltage mapping of the LA was performed intraoperatively before the catheter ablation procedure.

Results. LAA zones were registered in 33% of patients. Persistent form of AF, LA stiffness index, reservoir and contractile functions of the LA, E/A and E/e’ ratios became the strongest predictors of identifying LAA zones in the LA. A prognostic model was constructed using the LA stiffness index and E/A ratio, which determines a high probability of identifying LAA zones in the LA with a sensitivity and specificity of 74 and 74%, respectively.

Conclusion. Preoperative assessment of the stiffness index, reservoir and contractile function of the LA, E/A and E/e’ ratios has predictive value in assessing the prevalence of fibrosis using high-density voltage mapping of the LA. Studying of noninvasive ultrasound parameters in combination with known predictors of effectiveness will allow us to create algorithms for selecting patient selection for catheter ablation and avoid predictably ineffective interventions.

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