Ciaccio EJ, Hsia HH, Yarmohammadi H, MD EYW, Peters NS, Saluja D, Biviano AB. Atrial fibrillation substrate mapping with emphasis on voltage-based guidance. World J Cardiol 2025; 17(11): 109739 [DOI: 10.4330/wjc.v17.i11.109739]
Corresponding Author of This Article
Edward J Ciaccio, PhD, Senior Researcher, Division of Cardiology, Department of Medicine, Columbia University Medical Center, Room 9-934, 180 Fort Washington Avenue, New York, NY 10032, United States. ejc6@columbia.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Nov 26, 2025; 17(11): 109739 Published online Nov 26, 2025. doi: 10.4330/wjc.v17.i11.109739
Atrial fibrillation substrate mapping with emphasis on voltage-based guidance
Edward J Ciaccio, Henry H Hsia, Hirad Yarmohammadi, Elaine Y Wan MD, Nicholas S Peters, Deepak Saluja, Angelo B Biviano
Edward J Ciaccio, Hirad Yarmohammadi, Deepak Saluja, Angelo B Biviano, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, United States
Henry H Hsia, Cardiac Electrophysiology and Arrhythmia Service, University of California San Francisco, San Francisco, CA 94143, United States
Elaine Y Wan MD, Division of Cardiology, Columbia University, New York, NY 10032, United States
Nicholas S Peters, Imperial Centre for Cardiac Engineering, Imperial College London, London SW7 2AZ, United Kingdom
Author contributions: Ciaccio EJ wrote the manuscript; all co-authors reviewed the manuscript and provided helpful comments and suggestions; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: Angelo B Biviano is a medical Advisory Board member for AltaThera pharmaceuticals. The other authors have no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Edward J Ciaccio, PhD, Senior Researcher, Division of Cardiology, Department of Medicine, Columbia University Medical Center, Room 9-934, 180 Fort Washington Avenue, New York, NY 10032, United States. ejc6@columbia.edu
Received: May 20, 2025 Revised: June 16, 2025 Accepted: September 16, 2025 Published online: November 26, 2025 Processing time: 185 Days and 11.8 Hours
Core Tip
Core Tip: Voltage mapping is commonly used during substrate mapping to detect target areas for ablation in patients with atrial fibrillation (AF). Analysis of the substrate may take the form of detecting low voltage areas or the average voltage over an entire region. Often, areas which are targets for ablation are located where the voltage level is lower than normal, indicating disease and damage to the substrate. Furthermore, as AF progresses from paroxysmal to persistent type, the voltage level of the left atrium tends to diminish. This is often associated with atrial remodeling, in which structural and electrical changes occur during arrhythmia. Protocols for finding target areas using voltage mapping are described, and future research efforts to improve mapping and outcome are discussed.
