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Van Steenkiste G, Boussy T, Duytschaever M, Vernemmen I, Schauvlieghe S, Decloedt A, van Loon G. Detection of the origin of atrial tachycardia by 3D electro-anatomical mapping and treatment by radiofrequency catheter ablation in horses. J Vet Intern Med 2022; 36:1481-1490. [PMID: 35686355 PMCID: PMC9308432 DOI: 10.1111/jvim.16473] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Atrial tachycardia (AT) can be treated by medical or electrical cardioversion but the recurrence rate is high. Three-dimensional electro-anatomical mapping, recently described in horses, might be used to map AT to identify a focal source or reentry mechanism and to guide treatment by radiofrequency ablation. OBJECTIVES To describe the feasibility of 3D electro-anatomical mapping and radiofrequency catheter ablation to characterize and treat sustained AT in horses. ANIMALS Nine horses with sustained AT. METHODS Records from horses with sustained AT referred for radiofrequency ablation at Ghent University were reviewed. RESULTS The AT was drug resistant in 4 out of 9 horses. In 8 out of 9 horses, AT originated from a localized macro-reentrant circuit (n = 5) or a focal source (n = 3) located at the transition between the right atrium and the caudal vena cava. In these 8 horses, local radiofrequency catheter ablation resulted in the termination of AT. At follow-up, 6 out of 8 horses remained free of recurrence. CONCLUSIONS AND CLINICAL IMPORTANCE Differentiation between focal and macro-reentrant AT in horses is possible using 3D electro-anatomical mapping. In this study, the source of right atrial AT in horses was safely treated by radiofrequency catheter ablation.
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Affiliation(s)
- Glenn Van Steenkiste
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
| | - Tim Boussy
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | | | - Ingrid Vernemmen
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
| | - Stijn Schauvlieghe
- Department of Surgery and Anaesthesiology of Domestic Animals, Ghent University, Merelbeke, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
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Kefala A, Claridge S, Wijayagoonawardana P, Sadagopan S, Ullah W, Yue AM. Targeted cluster ablation of non‐CTI dependent atrial arrhythmias in congenital heart disease using ultra‐high definition mapping. J Cardiovasc Electrophysiol 2022; 33:932-942. [DOI: 10.1111/jce.15425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Kefala
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | - Simon Claridge
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | | | | | - Waqas Ullah
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | - Arthur M. Yue
- University Hospital SouthamptonSouthamptonUnited Kingdom
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P-Wave Morphology in Focal Atrial Tachycardia: An Updated Algorithm to Predict Site of Origin. JACC Clin Electrophysiol 2021; 7:1547-1556. [PMID: 34217661 DOI: 10.1016/j.jacep.2021.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to report P-wave morphology (PWM) from a series of paraseptal (PS) atrial tachycardia (AT), revise then prospectively evaluate a simplified PWM algorithm against a contemporary consecutive cohort with focal AT. BACKGROUND The 2006 PWM algorithm was useful in predicting the origin of focal AT. An updated algorithm was developed given advances in multipolar 3-dimensional mapping, potential limitations of PWM in separating PS sites, and a renewed interest in the P-wave in mapping non-pulmonary vein triggers. METHODS The PWM from a consecutive series of 67 patients with PS AT were analyzed. PS sites included were coronary sinus ostium, perinodal, left and right septum, septal tricuspid annulus, superior mitral annulus, and noncoronary cusp. Next the P-wave algorithm was revised and prospectively evaluated by 3 blinded assessors. RESULTS The P-wave for PS sites was neg/pos (n = 50), iso/pos (n = 10), or isoelectric (n = 4) in lead V1 (96%). The P-wave algorithm was modified and prospectively applied to 30 consecutive patients with focal AT who underwent successful ablation. Foci (n = 30) originated from the right atrium (33.3%), left atrium (30%), and PS (36.7%). Using the PW algorithm, the correct anatomic location was identified in 93%. Incorrect interpretation of the terminal positive P-wave component (n = 3) and initial negative P-wave deflection (n = 1) in lead V1 misidentified 4 paraseptal cases. CONCLUSIONS The revised PWM algorithm offers a simplified and accurate method of localizing the responsible site for focal AT. The P-wave remains an important first step in mapping atrial arrhythmias.
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Mapping strategies and ablation of premature atrial complexes. Herzschrittmacherther Elektrophysiol 2021; 32:9-13. [PMID: 33533993 DOI: 10.1007/s00399-021-00744-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
Premature atrial complexes (PACs) are a common finding in patients with structural heart disease, as well as in healthy subjects. In addition to the clinical spectrum ranging from asymptomatic patients to irritating palpitations, PACs are suggested to be associated with an increased risk of atrial fibrillation and stroke. Medical treatment leads to a significant reduction in PACs with clear symptom relief in a large proportion of patients, but is limited in cases of PACs that are refractory to antiarrhythmic drug (AAD) treatment. Furthermore, proarrhythmic effects of AAD or the patient's refusal of AAD treatment due to side effects need to be considered. Ablation of PACs is a good alternative to medical therapy with a comparable safety profile and at least comparable efficacy. In recent years, ultra-high-density (UHD) mapping with multiple improvements for successful ablation has been evolving. Before the introduction of UHD mapping, ablation strategies included activation mapping with single-tip catheters or conventional mapping aiming for the earliest activation of the PAC locally, with the earliest activation suspected to be the origin of the PAC and targeted by radiofrequency (RF) ablation. Using UHD mapping, a three-dimensional local activation map of the atrium can be acquired, identifying the point of earliest activation within the high-resolution map. PAC ablation has therefore developed into a true alternative for the treatment of symptomatic PACs.
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Jungen C, Akbulak R, Kahle AK, Eickholt C, Schaeffer B, Scherschel K, Dinshaw L, Muenkler P, Schleberger R, Nies M, Gunawardene MA, Klatt N, Hartmann J, Merbold L, Jularic M, Willems S, Meyer C. Outcome after tailored catheter ablation of atrial tachycardia using ultra-high-density mapping. J Cardiovasc Electrophysiol 2020; 31:2645-2652. [PMID: 32748442 DOI: 10.1111/jce.14703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Tailored catheter ablation of atrial tachycardias (ATs) is increasingly recommended as a potentially easy treatment strategy in the era of high-density mapping (HDM). As follow-up data are sparse, we here report outcomes after HDM-guided ablation of ATs in patients with prior catheter ablation or cardiac surgery. METHODS AND RESULTS In 250 consecutive patients (age 66.5 ± 0.7 years, 58% male) with ATs (98% prior catheter ablation, 13% prior cardiac surgery) an HDM-guided catheter ablation was performed with the support of a 64-electrode mini-basket catheter. A total of 354 ATs (1.4 ± 0.1 ATs per patient; mean cycle length 304 ± 4.3 ms; 64% macroreentry, 27% localized reentry, and 9% focal) with acute termination of 95% were targeted in the index procedure. A similar AT as in the index procedure recurred in five patients (2%) after a median follow-up time of 535 days (interquartile range (IQR) 25th-75th percentile: 217-841). Tailored ablation of reentry ATs with freedom from any arrhythmia was obtained in 53% after a single procedure and in 73% after 1.4 ± 0.4 ablation procedures (range: 1-4). A total of 228 patients (91%) were free from any arrhythmia recurrence after 210 days (IQR: 152-494) when including optimal usual care. CONCLUSIONS Tailored catheter ablation of ATs guided by HDM has a high acute success rate. The recurrence rate of the index AT is low. In patients with extensive atrial scaring further ablation procedures need to be considered to achieve freedom from any arrhythmia.
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Affiliation(s)
- Christiane Jungen
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Ruken Akbulak
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | | | - Benjamin Schaeffer
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Katharina Scherschel
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Leon Dinshaw
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Paula Muenkler
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Ruben Schleberger
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Moritz Nies
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | | | - Niklas Klatt
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jens Hartmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Mario Jularic
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Stephan Willems
- German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian Meyer
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany.,Institute of Neuronal and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Chieng D, Lahiri A, Sugumar H, Al‐Kaisey A, Parameswaran R, Anderson RD, Prabhu S, Ling L, Morton JB, McLellan AJ, Lee G, Kalman JM, McGavigan AD, Kistler PM. Multipolar mapping with the high‐density grid catheter compared with conventional point‐by‐point mapping to guide catheter ablation for focal arrhythmias. J Cardiovasc Electrophysiol 2020; 31:2288-2297. [DOI: 10.1111/jce.14636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- David Chieng
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | | | - Hariharan Sugumar
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Ahmed Al‐Kaisey
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Ramanathan Parameswaran
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Robert D. Anderson
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Sandeep Prabhu
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Liang‐Han Ling
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Joseph B. Morton
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Alex J. McLellan
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Geoffrey Lee
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Jonathan M. Kalman
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Cardiology Royal Melbourne Hospital Melbourne Australia
- Department of Medicine Monash Health Melbourne Australia
| | - Andrew D. McGavigan
- Department of Cardiology Flinders Medical Centre Adelaide Australia
- Faculty of Medicine Flinders University Adelaide Australia
| | - Peter M. Kistler
- Clinical Electrophysiology Laboratory The Baker Heart Research Institute Melbourne Australia
- Department of Cardiology The Alfred Hospital Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
- Department of Medicine Monash Health Melbourne Australia
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Alken FA, Chen S, Masjedi M, Pürerfellner H, Maury P, Martin CA, Sacher F, Jais P, Meyer C. Basket catheter-guided ultra-high-density mapping of cardiac arrhythmias: a systematic review and meta-analysis. Future Cardiol 2020; 16:735-751. [PMID: 32608246 DOI: 10.2217/fca-2020-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: Ultra-high-density mapping (HDM) is increasingly used for guidance of catheter ablation in cardiac arrhythmias. While initial results are promising, a systematic evaluation of long-term outcome has not been performed so far. Methods: A systematic review and meta-analysis was conducted on studies investigating long-term outcome after Rhythmia HDM-guided atrial fibrillation (AF) or atrial tachycardia catheter ablation. Results: Beyond multiple studies providing novel insights into arrhythmia mechanisms, follow-up data from 17 studies analyzing Rhythmia HDM-guided ablation (1768 patients, 49% with previous ablation) were investigated. Cumulative acute success was 100/90.2%, while 12 months long-term pooled success displayed at 71.6/71.2% (AF/atrial tachycardia). Prospective data are limited, showing similar outcome between HDM-guided and conventional AF ablation. Conclusion: Acute results of HDM-guided catheter ablation are promising, while long-term success is challenged by complex arrhythmogenic substrates. Prospective randomized trials investigating different HDM-guided ablation strategies are warranted and underway.
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Affiliation(s)
- Fares-Alexander Alken
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - Mustafa Masjedi
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Helmut Pürerfellner
- Department of Electrophysiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France
| | - Claire A Martin
- Royal Papworth Hospital National Health Service Foundation Trust, Cambridge, UK
| | - Frederic Sacher
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Christian Meyer
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiology, Evangelical Hospital Düsseldorf, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Heinrich-Heine-University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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8
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Moore JP, Buch E, Gallotti RG, Shannon KM. Ultrahigh‐density mapping supplemented with global chamber activation identifies noncavotricuspid‐dependent intra‐atrial re‐entry conduction isthmuses in adult congenital heart disease. J Cardiovasc Electrophysiol 2019; 30:2797-2805. [DOI: 10.1111/jce.14251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jeremy P. Moore
- UCLA Medical CenterAhmanson/UCLA Adult Congenital Heart Disease CenterLos Angeles California
| | - Eric Buch
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Roberto G. Gallotti
- UCLA Medical CenterAhmanson/UCLA Adult Congenital Heart Disease CenterLos Angeles California
| | - Kevin M. Shannon
- UCLA Medical CenterAhmanson/UCLA Adult Congenital Heart Disease CenterLos Angeles California
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Laţcu DG, Saoudi N. High-resolution/Density Mapping in Patients with Atrial and Ventricular Arrhythmias. Card Electrophysiol Clin 2019; 11:511-524. [PMID: 31400875 DOI: 10.1016/j.ccep.2019.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
High-definition/ultra-high-definition mapping, owing to an impressive increase of the point density of electroanatomic maps, provides improved substrate characterization, better understanding of the arrhythmia mechanism, and a better selection of the ablation target in patients with atrial and ventricular arrhythmias. Despite the scarce comparative data on ablation results versus standard mapping, ultra-high-definition mapping is increasingly used by the electrophysiology community.
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Affiliation(s)
| | - Nadir Saoudi
- Centre Hospitalier Princesse Grace, Avenue Pasteur, 98000 Monaco
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10
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Scaglione M, Caponi D, Di Donna P, Battaglia A. Ultra-high definition mapping to choose the optimal ablation strategy in atrial macro-re-entrant tachycardia. Europace 2019; 21:iii13-iii14. [PMID: 31400217 DOI: 10.1093/europace/euz149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marco Scaglione
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante 202, Asti, Italy
| | - Domenico Caponi
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante 202, Asti, Italy
| | - Paolo Di Donna
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante 202, Asti, Italy
| | - Alberto Battaglia
- Division of Cardiology, Cardinal G. Massaia Hospital, C.so Dante 202, Asti, Italy
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Atrial Tachycardia With Atrial Activation Duration Exceeding the Tachycardia Cycle Length: Mechanisms and Prevalence. JACC Clin Electrophysiol 2019; 5:907-916. [PMID: 31439291 DOI: 10.1016/j.jacep.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study sought to identify atrial tachycardia (AT) demonstrating atrial activation duration (AAD) lasting longer than the length of the tachycardia cycle (TCL); to assess AT prevalence; and to evaluate the mechanisms and characteristics associated with these AT episodes by using the Rhythmia system (Boston Scientific, Marlborough, Massachusetts). BACKGROUND Ultra-high-density mapping allows very accurate characterization of mechanisms involved in AT. Some complex patterns may involve AAD which is longer than the tachycardia cycle length (TCL) which makes maps difficult to interpret. Prevalence and characteristics of such ATs are unknown. METHODS A cohort of 100 consecutive patients undergoing ablation of 125 right (n = 21) or left (n = 104) ATs using ultra-high-density mapping were retrospectively included. Offline calculation of right or left AAD was compared to TCL. RESULTS Mean TCL was 293 ± 65 ms, and mean AAD was 291 ± 74 ms (p = NS). AT mechanisms were macro-re-entry in 74 cases (59%), localized re-entry in 27 cases (22%), and focal AT in 21 cases (17%) (types were mixed in 3 cases). Fifteen ATs (12%) had AADs that were longer than the TCL (71 ± 45 ms longer, from 10 to 150 ms). TCL was equal to the AAD in 97 ATs (78%), whereas 13 ATs (10%) had AAD shorter than the TCL (focal AT in each case). There were no differences between right and left atria for prevalence of ATs with AADs that were longer than the TCLs. There were significant differences in AT mechanisms according to the AAD-to-TCL ratio (p < 0.0001), with localized re-entry showing more often that AAD was longer than the TCL compared to that in focal AT and macro-re-entry. CONCLUSIONS ATs with AAD lasting longer than the TCL were present in approximately 10% of the ATs referred for ablation, mostly in ATs caused by localized re-entry. Ultra-high-density mapping allows detection of these complex patterns of activation.
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