We thank Hong et al. for their interest in our work and their comments. In response to their specific points, a bipolar voltage cutoff < 0.5 mV was used to detect low-voltage areas using high-density multielectrode catheters with 1-mm electrodes and 2-mm electrode spacing. The majority (8 of 10) of published studies in the field of catheter ablation for persistent atrial fibrillation have used the same cutoff. We acknowledge the need for histologic correlation; however, this approach is based on best currently available data.
- Anter E
- Tschabrunn CM
- Josephson ME
High-resolution mapping of scar-related atrial arrhythmias using smaller electrodes with closer interelectrode spacing.
Circ Arrhythm Electrophysiol. 2015; 8: 537-545
- Rolf S
- Kircher S
- Arya A
- et al.
Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation.
Circ Arrhythm Electrophysiol. 2014; 7: 825-833
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- High-resolution mapping of scar-related atrial arrhythmias using smaller electrodes with closer interelectrode spacing.Circ Arrhythm Electrophysiol. 2015; 8: 537-545
- Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation.Circ Arrhythm Electrophysiol. 2014; 7: 825-833
- Resolving bipolar electrogram voltages during atrial fibrillation using omnipolar mapping.Circ Arrhythm Electrophysiol. 2017; 10e005018
- Catheter ablation of low-voltage areas for persistent atrial fibrillation: procedural outcomes using high-density voltage mapping.Can J Cardiol. 2020; 36: 1956-1964
Published online: March 25, 2021
Accepted: March 18, 2021
Received: March 16, 2021
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Ablation of Low-Voltage Areas for Persistent Atrial Fibrillation: Procedural Outcomes Using High-Density Voltage MappingCanadian Journal of CardiologyVol. 37Issue 8
- PreviewWe reviewed with interest the article by Nery et al. describing catheter ablation of low-voltage areas in the treatment of persistent atrial fibrillation.1 The authors should be commended on this study, particularly given that the previously reported success rates for catheter ablation of persistent atrial fibrillation are 43% following a single procedure using any ablation technique.2 In this study, the authors found that by targeting low-voltage areas in addition to performing a pulmonary vein isolation, there was an increased freedom from atrial tachycardia and atrial fibrillation from 58% to 72% at 18 months with no additional complications noted.