{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:51:20Z","timestamp":1791258680962,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low\u2010voltage areas (LVAs) detected via electroanatomic mapping (EAM) are key indicators of atrial remodeling and predictors of atrial fibrillation (AF) recurrence following pulmonary vein isolation (PVI). However, manual LVA quantification is time\u2010intensive, operator\u2010dependent, and prone to variability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To validate the accuracy, consistency, and efficiency of automatic LVA quantification function of CARTONET\u2014a cloud\u2010based automated platform for LVA quantification\u2014by comparing it with conventional manual analysis in AF patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 100 patients who underwent PVI for AF at a single center between January 2022 and December 2023. Manual LVA measurements were performed by experts using CARTO3. LVA quantification and anatomical segmentation were performed using CARTONET. LVA was stratified into four categories: low (&lt;5%), mild (5%\u201320%), moderate (20%\u201335%), and severe (&gt;35%). Statistical analyses included Spearman's rank correlation (\u03c1), Bland\u2013Altman agreement, and confusion matrices for categorical classification, with subgroup analysis based on segmentation errors and map point density. The number and the locations of segmentation errors were quantified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      CARTONET demonstrated strong correlation with manual measurements across all LA regions (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u00a0=\u00a00.928\u20130.983,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01). Significant differences were observed in anterior and posterior walls (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01), especially in low\u2010density maps. In high\u2010density maps, no significant differences were observed (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0\u2265\u00a00.07). Bland\u2013Altman analysis showed minimal bias (mean difference: \u22120.8%), and 96% of values fell within limits of agreement. The confusion matrix showed that categorical agreement for LVA stratification exceeded 90%. Segmentation errors were most common at the LSPV but did not significantly impact LVA quantification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CARTONET offers reliable, efficient LVA quantification with high concordance to manual methods. Its performance in high\u2010quality maps supports its use in clinical and research settings, reducing operator workload and promoting standardized substrate evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70313","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:07:51Z","timestamp":1781068071000},"page":"1487-1495","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation of Automated Low Voltage Area Measurement Using CARTONET in Atrial Fibrillation Patients"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6920-6969","authenticated-orcid":false,"given":"Yuncong","family":"Mao","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins Medicine  Baltimore Maryland USA"},{"name":"Stanford School of Medicine  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6212-7052","authenticated-orcid":false,"given":"Tarif","family":"Bitar","sequence":"additional","affiliation":[{"name":"Department of Cardiology Krankenhaus Porz am Rhein  Cologne Germany"},{"name":"Department of Cardiology, Faculty of Health, School of Medicine University Witten\/Herdecke  Witten Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Horlitz","sequence":"additional","affiliation":[{"name":"Department of Cardiology Krankenhaus Porz am Rhein  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Yusuf Ali","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Yungher","sequence":"additional","affiliation":[{"name":"Biosense Webster Ltd. Haifa Technology Center  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Horlitz","sequence":"additional","affiliation":[{"name":"Department of Cardiology Krankenhaus Porz am Rhein  Cologne Germany"},{"name":"Department of Cardiology, Faculty of Health, School of Medicine University Witten\/Herdecke  Witten Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Trayanova","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"St\u00f6ckigt","sequence":"additional","affiliation":[{"name":"Department of Cardiology Krankenhaus Porz am Rhein  Cologne Germany"},{"name":"Department of Internal Medicine II University Hospital Bonn  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazan","family":"Mohsen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Johns Hopkins Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.23722"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2024.05.013"},{"key":"e_1_2_11_4_1","article-title":"Non\u2010Pulmonary Vein Triggers of Atrial Fibrillation Are Likely to Arise From Low\u2010Voltage Areas in the","volume":"9","author":"Kawai S.","year":"2019","journal-title":"Left Atrium Science Reports"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euad194"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2024.e26858","article-title":"Slow Blood\u2010Flow in 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