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ORIGINAL RESEARCH article

Front. Physiol.
Sec. Cardiac Electrophysiology
Volume 15 - 2024 | doi: 10.3389/fphys.2024.1474568

Left Atrial Spatial Entropy: a novel tool for electrophysiological substrate characterization in atrial fibrillation

Provisionally accepted
Lorenzo Gigli Lorenzo Gigli 1Alberto Preda Alberto Preda 1*Davide Coluzzi Davide Coluzzi 2Marta Sartore Marta Sartore 2Muhamed Vila Muhamed Vila 2Marco Carbonaro Marco Carbonaro 1Matteo Baroni Matteo Baroni 1Marisa Varrenti Marisa Varrenti 1Sara Vargiu Sara Vargiu 1Fabrizio Guarracini Fabrizio Guarracini 1Antonio Frontera Antonio Frontera 1Luigi Pannone Luigi Pannone 3Gian Battista Chierchia Gian Battista Chierchia 3Carlo de Asmundis Carlo de Asmundis 3Patrizio Mazzone Patrizio Mazzone 1Roberto Sassi Roberto Sassi 2
  • 1 Cardio Center, Niguarda Ca' Granda Hospital, Milano, Italy
  • 2 University of Milan, Milan, Lombardy, Italy
  • 3 Heart Rhythm Management Center, University Hospital Brussels, Brussels, Belgium

The final, formatted version of the article will be published soon.

    Background: Electrical remodeling has been linked to atrial fibrillation (AF) progression and recurrence after catheter ablation (CA). Substrate mapping based solely on voltage amplitude electrogram does not provide a comprehensive understanding of the left atrial (LA) disease. The aim of this study is to assess left atrial spatial entropy (LASE) from voltage maps routinely obtained during AF ablation to further characterize LA substrate.High-density electroanatomic maps (EAMs) of 27 patients with paroxysmal or persistent AF undergoing routine CA were prospectively collected. From voltage maps, a computational postprocessing was performed. By using the Shannon Entropy model, the probability distribution of the amplitude range values associated to each point of the map was used to measure LASE. Finally, correlations between LASE and AF clinical and electrophysiological characteristics were explored.Results: LASE differentiated patients with paroxysmal and persistent AF (6.45 ± 0.41 vs. 5.87 ± 0.53, p= 0.028) as well as patients with normal and abnormal LA substrate (6.42 ± 0.42 vs. 5.87 ± 0.56, p= 0.043) independently from the basal rhythm during EM acquisition (6.33 ± 0.41 vs. 6.11 ± 0.63, p=0.619). Accordance between LASE and EAM was assessed by ROC analysis (AUC 0.81, C.I.: 0.62 -0.99, Youden index 6.06, sensitivity 80%, specificity 80%). Patients with the lowest LASE reported AF recurrence at follow up. Conclusion: LASE may have a role in further characterization of LA substrate and the type of AF independently from basal rhythm.

    Keywords: Atrial Fibrillation, Left Atrial Spatial Entropy, Catheter Ablation, Substrate characterization, mapping technologies

    Received: 01 Aug 2024; Accepted: 31 Oct 2024.

    Copyright: © 2024 Gigli, Preda, Coluzzi, Sartore, Vila, Carbonaro, Baroni, Varrenti, Vargiu, Guarracini, Frontera, Pannone, Chierchia, de Asmundis, Mazzone and Sassi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Alberto Preda, Cardio Center, Niguarda Ca' Granda Hospital, Milano, Italy

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