{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:43:22Z","timestamp":1787237002510,"version":"build-2736575974"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T00:00:00Z","timestamp":1666051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low-voltage-substrate (LVS)-guided ablation for persistent atrial fibrillation (AF) has been described either in sinus rhythm (SR) or AF. Prolonged fractionated potentials (PFPs) may represent arrhythmogenic slow conduction substrate and potentially co-localize with LVS. We assess the spatial correlation of PFP identified in AF (PFP-AF) to those mapped in SR (PFP-SR). We further report the relationship between LVS and PFPs when mapped in AF or SR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Thirty-eight patients with ablation na\u00efve persistent AF underwent left atrial (LA) high\u2014density mapping in AF and SR prior to catheter ablation. Areas presenting PFP-AF and PFP-SR were annotated during mapping on the LA geometry. Low-voltage areas (LVA) were quantified using a bipolar threshold of 0.5 mV during both AF and SR mapping. Concordance of fractionated potentials (CFP) (defined as the presence of PFPs in both rhythms within a radius of 6 mm) was quantified. Spatial distribution and correlation of PFP and CFP with LVA were assessed. The predictors for CFP were determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PFPs displayed low voltages both during AF (median 0.30 mV (Q1\u2013Q3: 0.20\u20130.50 mV) and SR (median 0.35 mV (Q1\u2013Q3: 0.20\u20130.56 mV). The duration of PFP-SR was measured at 61 ms (Q1\u2013Q3: 51\u201376 ms). During SR, most PFP-SRs (89.4 and 97.2%) were located within LVA (&amp;lt;0.5 mV and &amp;lt;1.0 mV, respectively). Areas presenting PFP occurred more frequently in AF than in SR (median: 9.5 vs. 8.0,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.005). Both PFP-AF and PFP-SR were predominantly located at anterior LA (&amp;gt;40%), followed by posterior LA (&amp;gt;20%) and septal LA (&amp;gt;15%). The extent of LVA &amp;lt; 0.5 mV was more extensive in AF (median: 25.2% of LA surface, Q1\u2013Q3:16.6\u201350.5%) than in SR (median: 12.3%, Q1\u2013Q3: 4.7\u201329.4%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001). CFP in both rhythms occurred in 80% of PFP-SR and 59% of PFP-AF (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.008). Notably, CFP was positively correlated to the extent of LVA in SR (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.004), but not with LVA in AF (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.226). Additionally, the extent of LVA &amp;lt; 0.5 mV in SR was the only significant predictor for CFP, with an optimal threshold of 16% predicting high (&amp;gt;80%) fractionation concordance in AF and SR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Substrate mapping in SR vs. AF reveals smaller areas of low voltage and fewer sites with PFP. PFP-SR are located within low-voltage areas in SR. There is a high degree of spatial agreement (80%) between PFP-AF and PFP-SR in patients with moderate LVA in SR (&amp;gt;16% of LA surface). These findings should be considered when substrate-based ablation strategies are applied in patients with the left atrial low-voltage substrate with recurrent persistent AF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2022.1000027","type":"journal-article","created":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T00:35:53Z","timestamp":1666053353000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Validating left atrial fractionation and low-voltage substrate during atrial fibrillation and sinus rhythm\u2014A high-density mapping study in persistent atrial fibrillation"],"prefix":"10.3389","volume":"9","author":[{"given":"Taiyuan","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"M\u00fcller-Edenborn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Mayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Eichenlaub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoraida","family":"Moreno Weidmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juergen","family":"Allgeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Bohnen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiko","family":"Lehrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Trenk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Schoechlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Arentz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Jadidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1056\/NEJM199809033391003","article-title":"Spontaneous 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