{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:39:44Z","timestamp":1781649584763,"version":"3.54.5"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2021,1,2]],"date-time":"2021-01-02T00:00:00Z","timestamp":1609545600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,2]],"date-time":"2021-01-02T00:00:00Z","timestamp":1609545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005632","name":"Narodowe Centrum Bada\u0144 i Rozwoju","doi-asserted-by":"publisher","award":["002\/RID\/2018\/19"],"award-info":[{"award-number":["002\/RID\/2018\/19"]}],"id":[{"id":"10.13039\/501100005632","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Heart Vessels"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>It was hypothesised that left atrial (LA) fibrosis identified by the presence of low-voltage areas (LVA) may influence the mechanical and electrical function of the left (LAA) and right (RAA) atrial appendage among the long-standing persistent atrial fibrillation (LSPAF) population. 140 consecutive patients underwent voltage mapping of LA with a multielectrode catheter following pulmonary vein isolation and restoration of sinus rhythm with cardioversion. Echocardiography determined LAA peak outflow and inflow velocities and intracardiac catheter-based mean LAA and RAA AF cycle length (AFCL) were obtained during AF before ablation. The impact of flow velocities and AFCL on the prevalence and location of LVA was further evaluated. LVA were detected in 54% of the patients. 14% of the patients presented severe global LVA burden\u2009&gt;\u200920% of the total LA surface area. 29% of the patients presented a disseminated pattern of remodelling as 3 out of 5 LA segments were affected. LAA AFCL, RAA AFCL, LAA flow velocities did not predict the absolute presence of LVA. However LAA AFCL\u2009&gt;\u2009155\u00a0ms predicted disseminated LVA pattern and LAA AFCL\u2009&gt;\u2009165\u00a0ms severe LVA incidence. LAA AFCL\u2009&gt;\u2009155\u00a0ms was predictive for existence of LVA within antero-septal LA segments whilst LAA emptying velocity\u2009\u2264\u20090.2\u00a0m\/s within lateral wall. Moreover RAA AFCL\u2009&gt;\u2009165\u00a0ms was strongly related to the presence of LAA AFCL\u2009&gt;\u200915\u00a0ms and\u2009&gt;\u2009165\u00a0ms. LAA and RAA functional assessment was predictive of the presence of advanced stages of voltage-defined LA fibrosis and its regional distribution among LSPAF population<\/jats:p>","DOI":"10.1007\/s00380-020-01752-4","type":"journal-article","created":{"date-parts":[[2021,1,2]],"date-time":"2021-01-02T14:02:38Z","timestamp":1609596158000},"page":"853-862","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Left and right atrial appendage functional features as predictors for voltage-defined left atrial remodelling in patients with long-standing persistent atrial fibrillation"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6747-6615","authenticated-orcid":false,"given":"Radoslaw Marek","family":"Kiedrowicz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Wielusinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Wojtarowicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaroslaw","family":"Kazmierczak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,2]]},"reference":[{"key":"1752_CR1","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1111\/pace.13015","volume":"40","author":"A Blandino","year":"2017","unstructured":"Blandino A, Bianchi F, Grossi S, Biondi-Zoccai G, Conte MR, Gaido L, Gaita F, Scaglione M, Rametta F (2017) Left atrial substrate modification targeting low-voltage areas for catheter ablation of atrial fibrillation: a systematic review and metaanalysis. Pacing Clin Electrophysiol 40:199\u2013212","journal-title":"Pacing Clin Electrophysiol"},{"key":"1752_CR2","doi-asserted-by":"publisher","DOI":"10.5603\/CJ.a2020.0069","author":"R Kiedrowicz","year":"2020","unstructured":"Kiedrowicz R, Wielusinski M, Wojtarowicz A, Kazmierczak J (2020) Predictors of the voltage derived atrial fibrosis in patients with long-standing persistent atrial fibrillation. Cardiol J. https:\/\/doi.org\/10.5603\/CJ.a2020.0069","journal-title":"Cardiol J"},{"key":"1752_CR3","doi-asserted-by":"publisher","first-page":"e003382","DOI":"10.1161\/CIRCEP.115.003382","volume":"9","author":"G Yang","year":"2016","unstructured":"Yang G, Yang B, Wei Y, Zhang F, Ju W, Chen H, Li M, Gu K, Lin Y, Wang B, Cao K, Kojodjojo P, Chen M (2016) Catheter ablation of nonparoxysmal atrial fibrillation using electrophysiologically guided substrate modification during sinus rhythm after pulmonary vein isolation. Circ Arrhythm Electrophysiol 9:e003382","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"1752_CR4","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1111\/jce.13278","volume":"28","author":"D Schreiber","year":"2017","unstructured":"Schreiber D, Rieger A, Moser F, Kottkamp H (2017) Catheter ablation of atrial fibrillation with box isolation of fibrotic areas: Lessons on fibrosis distribution and extent, clinical characteristics, and their impact on long-term outcome. J Cardiovasc Electrophysiol 28:971\u2013983","journal-title":"J Cardiovasc Electrophysiol"},{"key":"1752_CR5","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/ehjci\/jev014","volume":"16","author":"RM Lang","year":"2015","unstructured":"Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the european association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging 16:233\u2013270","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"1752_CR6","doi-asserted-by":"publisher","first-page":"3554","DOI":"10.1161\/STROKEAHA.115.011273","volume":"46","author":"S Yaghi","year":"2015","unstructured":"Yaghi S, Song C, Gray WA, Furie KL, Elkind MS, Kamel H (2015) Left atrial appendage function and stroke risk. Stroke 46:3554\u20133559","journal-title":"Stroke"},{"key":"1752_CR7","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/s10840-006-9045-1","volume":"16","author":"MD O\u2019Neill","year":"2006","unstructured":"O\u2019Neill MD, Ja\u0131s P, Takahashi Y, Jonsson A, Sacher F, Hocini M, Sanders P, Rostock T, Rotter M, Pernat A, Clementy J, Haissaguerre M (2006) The stepwise ablation approach for chronic atrial fibrillation: evidence for a cumulative effect. J Interv Card Electrophysiol 16:153\u2013167","journal-title":"J Interv Card Electrophysiol"},{"key":"1752_CR8","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1111\/j.1540-8159.2009.02659.x","volume":"33","author":"SY Ho","year":"2010","unstructured":"Ho SY, McCarthy KP (2010) Anatomy of the left atrium for interventional electrophysiologists. Pacing Clin Electrophysiol 33:620\u2013627","journal-title":"Pacing Clin Electrophysiol"},{"key":"1752_CR9","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1046\/j.1540-8167.2003.02386.x","volume":"14","author":"L Macle","year":"2003","unstructured":"Macle L, Jais P, Scavee WR, Shah D, Hocini M, Choi KJ, Raybaud F, Clementy J, Haissaguerre M (2003) Electrophysiologically guided pulmonary vein isolation during sustained atrial fibrillation. J Cardiovasc Electrophysiol 14:255\u2013260","journal-title":"J Cardiovasc Electrophysiol"},{"key":"1752_CR10","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/j.amjcard.2005.11.019","volume":"97","author":"YL Douglas","year":"2006","unstructured":"Douglas YL, Jongbloed MR, Gittenberger-de Groot AC, Evers D, Dion RA, Voigt P, Bartelings MM, Schalij MJ, Ebels T, DeRuiter MC (2006) Histology of vascular myocardial wall of left atrial body after pulmonary venous incorporation. Am J Cardiol 97:662\u2013670","journal-title":"Am J Cardiol"},{"key":"1752_CR11","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1161\/CIRCEP.111.962720","volume":"5","author":"SY Ho","year":"2012","unstructured":"Ho SY, Cabrera JA, Sanchez-Quintana D (2012) Left atrial anatomy revisited. Circ Arrhythm Electrophysiol 5:220\u2013228","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"1752_CR12","doi-asserted-by":"publisher","first-page":"2504","DOI":"10.1016\/j.jacc.2006.02.047","volume":"47","author":"L Calo","year":"2006","unstructured":"Calo L, Lamberti F, Loricchio ML, De Ruvo E, Colivicchi F, Bianconi L, Pandozi C, Santini M (2006) Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: a prospective and randomized study. J Am Coll Cardiol 47:2504\u20132512","journal-title":"J Am Coll Cardiol"},{"key":"1752_CR13","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1016\/j.hrthm.2007.09.027","volume":"5","author":"A Verma","year":"2008","unstructured":"Verma A, Novak P, Macle L, Whaley B, Beardsall M, Wulffhart Z, Khaykin Y (2008) A prospective, multicenter evaluation of ablating complex fractionated electrograms (CFEs) during atrial fibrillation (AF) identified by an automated mapping algorithm: acute effects on AF and efficacy as an adjuvant strategy. Heart Rhythm 5:198\u2013205","journal-title":"Heart Rhythm"},{"key":"1752_CR14","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s10840-013-9820-8","volume":"38","author":"TJ Brakel","year":"2013","unstructured":"Brakel TJ, van der Krieken T, Westra SJ, van der Laak JA, Smeets JL, Swieten HA (2013) Fibrosis and electrophysiological characteristics of the atrial appendage in patients with atrial fibrillation and structural heart disease. Interv Card Electrophysiol 38:85\u201393","journal-title":"Interv Card Electrophysiol"},{"key":"1752_CR15","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1016\/S0735-1097(99)00472-6","volume":"34","author":"Y Agmon","year":"1999","unstructured":"Agmon Y, Khandheria BK, Gentile F, Seward JB (1999) Echocardiographic assessment of the left atrial appendage. J Am Coll Cardiol 34:1867\u20131877","journal-title":"J Am Coll Cardiol"},{"key":"1752_CR16","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1253\/circj.CJ-12-0934","volume":"77","author":"K Kumagai","year":"2013","unstructured":"Kumagai K, Sakamoto T, Nakamura K, Hayano M, Yamashita E, Oshima S (2013) Pre-procedural prediction of termination of persistent atrial fibrillation by catheter ablation as an indicator of reverse remodeling of the left atrium. Circ J 77:1416\u20131423","journal-title":"Circ J"},{"key":"1752_CR17","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s10840-019-00532-z","volume":"56","author":"Y Hori","year":"2019","unstructured":"Hori Y, Nakahara S, Nishiyama N, Fukuda R, Ukaji T, Hirotsugu S, Koshikawa Y, Inami S, Ishikawa T, Kobayashi S, Sakai Y, Taguchi I (2019) Impact of low-voltage zones on the left atrial anterior wall on the reduction in the left atrial appendage flow velocity in persistent atrial fibrillation patients. J Interv Card Electrophysiol 56:299\u2013306","journal-title":"J Interv Card Electrophysiol"},{"key":"1752_CR18","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.12.014","volume":"26","author":"Y Matsumoto","year":"2017","unstructured":"Matsumoto Y, Morino Y, Kumagai A, Hozawa M, Nakamura M, Terayama Y, Tashiro A (2017) Characteristics of anatomy and function of the left atrial appendage and their relationships in patients with cardioembolic stroke: a 3-dimensional transesophageal echocardiography study. J Stroke Cerebrovasc Dis 26:470\u2013479","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"1752_CR19","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1093\/europace\/eux082","volume":"20","author":"Y Huo","year":"2018","unstructured":"Huo Y, Gaspar T, Pohl M, Sitzy J, Richter U, Neudeck S, Mayer J, Kronborg M, Piorkowsky C (2018) Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation. Europace 20:956\u2013962","journal-title":"Europace"},{"key":"1752_CR20","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1093\/europace\/euz297","volume":"22","author":"B M\u00fcller-Edenborn","year":"2020","unstructured":"M\u00fcller-Edenborn B, Chen J, Allgeier J, Didenko M, Moreno-Weidmann Z, Neumann FJ, Lehrmann H, Weber R, Arentz T, Jadidi A (2020) Amplified sinus-P-wave reveals localization and extent of left atrial low-voltage substrate: implications for arrhythmia freedom following pulmonary vein isolation. Europace 22:240\u2013249","journal-title":"Europace"},{"key":"1752_CR21","doi-asserted-by":"publisher","first-page":"1959","DOI":"10.1093\/europace\/euy095","volume":"20","author":"EM Benito","year":"2018","unstructured":"Benito EM, Cabanelas N, Nunez-Garcia M, Alarcon F, Figueras I, Ventura RM, Soto-Iglesias D, Guasch E, Prat-Gonzalez S, Perea RJ, Borras R, Butakoff C, Camara O, Bisbal F, Arbelo E, Tolosana JM, Brugada J, Berruezo A, Mont L (2018) Preferential regional distribution of atrial fibrosis in posterior wall around left inferior pulmonary vein as identified by late gadolinium enhancement cardiac magnetic resonance in patients with atrial fibrillation. Europace 20:1959\u20131965","journal-title":"Europace"}],"container-title":["Heart and Vessels"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00380-020-01752-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00380-020-01752-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00380-020-01752-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T04:02:54Z","timestamp":1620100974000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00380-020-01752-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,2]]},"references-count":21,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["1752"],"URL":"https:\/\/doi.org\/10.1007\/s00380-020-01752-4","relation":{},"ISSN":["0910-8327","1615-2573"],"issn-type":[{"value":"0910-8327","type":"print"},{"value":"1615-2573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,2]]},"assertion":[{"value":"14 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 December 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"RMK has received fellowship support from BW. RMK, MW and JK have received educational support, travel grants, compensation for proctoring services from BW. AW declares no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}