Introduction
Atrial fibrosis is the most important predictor of arrhythmia recurrence following pulmonary vein (PV) isolation and is a marker of AF persistence and progression. [1] Despite the importance of this there is no common consensus on the optimal method of visualizing fibrosis. Delayed enhanced magnetic resonance imaging often lacks adequate resolution and has a significant potential for artefact. [2] Although high density bipolar voltage mapping during sinus rhythm (SR) may be considered a surrogate for the presence of fibrosis [3] there are many potential factors which may influence these recordings including wavefront dynamics, electrode orientation, spacing and size. [4] Importantly many patient who attend for catheter ablation for AF are not in SR at the time of the procedure and there is no clear correlation between substrate mapping during either arrhythmia. Voltage recordings during AF (AFv) are calculated as the maximum peak to peak within a window of interest and vary significantly from voltage recordings made during sinus rhythm (SRv).
The objective of our study was to assess whether there is a clear relationship between the mean AFv recorded over various durations and the SRv.