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Takigawa M, Martin CA, Yamamoto T, Nakatani Y, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Nishimura T, Tao S, Miyazaki S, Goya M, Haïssaguerre M, Sasano T, Jaïs P. Demonstration of the discrepancy between AT-wave morphology on 12-lead ECG and AT mechanism in scar-related AT. Pacing Clin Electrophysiol 2023; 46:515-518. [PMID: 36690018 DOI: 10.1111/pace.14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/17/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
The 12-lead electrocardiogram (ECG) is a fundamental modality to help determine the mechanism and the localization of atrial tachycardias (ATs). Although macroreentrant ATs and focal ATs typically show F-waves and discrete P-waves respectively on the 12-lead ECG, this is not universally the case in scar-related ATs.1, We present three cases clearly showing the discrepancy between the AT morphology on the 12-lead ECG and the AT-mechanism.
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Affiliation(s)
- Masateru Takigawa
- Tokyo Medical and Dental University, Tokyo, Japan
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | | | - Yosuke Nakatani
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | - Thomas Pambrun
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | - Meleze Hocini
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
| | | | - Susumu Tao
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | - Pierre Jaïs
- Liryc Institute, CHU Bordeaux, Univ.Bordeaux, Bordeaux, France
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2
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Maury P, Tabuteau M, Mandel F, Delasnerie H, Beneyto M, Voglimacci-Stephanopoli Q, Rollin A. First three-dimensional documentation of double-wave reentry in humans. HeartRhythm Case Rep 2021; 7:374-377. [PMID: 34194983 PMCID: PMC8226329 DOI: 10.1016/j.hrcr.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France.,I2MC, INSERM UMR 1297, Toulouse, France
| | | | - Franck Mandel
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Hubert Delasnerie
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Maxime Beneyto
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
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3
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Chugh A. Mapping and ablation of post-AF atrial tachycardias. J Cardiovasc Electrophysiol 2021; 32:2830-2844. [PMID: 33928695 DOI: 10.1111/jce.15047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
Atrial tachycardias are commonly encountered in patients undergoing catheter ablation of persistent atrial fibrillation (AF). Unlike typical atrial flutter that can be readily recognized and ablated, these post-AF tachycardias can arise from a wide variety of locations and involve a multiplicity of mechanisms. Apart from diagnostic challenges, radiofrequency ablation to eliminate the tachycardias may require multiple approaches. In addition, specialized techniques such as epicardial and chemical ablation may be required for definitive treatment. This review describes the various mechanisms and approaches to mapping and ablation of these challenging tachycardias.
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Affiliation(s)
- Aman Chugh
- Division of Cardiovascular Medicine, Section of Cardiac Electrophysiology, University of Michigan, Ann Arbor, Michigan, USA
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Differentiating atrial tachycardias with centrifugal activation: Lessons from high-resolution mapping. Heart Rhythm 2021; 18:1122-1131. [PMID: 33794392 DOI: 10.1016/j.hrthm.2021.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Centrifugal activation is not always the origin of a focal atrial tachycardia (AT) ("true-focal"), but passive activation from the other structures ("pseudo-focal"). OBJECTIVE We aimed to establish a method to differentiate true-focal from pseudo-focal. METHODS In 49 centrifugal activations in 35 patients with AT, 12-lead electrocardiogram, activation map, atrial global activation histogram (GAH), and local electrograms were analyzed. GAH demonstrates the relation between the activation area and timing through the cycle length, displayed with a normalized value, ranging from 0 (smallest activation area) to 1.0 (largest activation area). RESULTS Of 30 centrifugal activations observed in the septal region, 6/30 (20.0%) were true-focal. The remaining 24/60 (80.0%) were pseudo-focal, of which 23 (95.8%) were from the opposite chamber. P-wave/flutter-wave duration < 200 ms discriminated true-focal from pseudo-focal (sensitivity 100%; specificity 54.5%; positive predictive value 33.3%; negative predictive value 100%). Multiple breakthrough ruled out the possibility of a true-focal AT. Other differentiating factors were an activation area within the initial 20 ms of <5 mm2 and a typical QS pattern electrogram at the origin. Of 19 centrifugal activations observed outside the septal regions, 7 were true-focal and 12 were pseudo-focal exited from an epicardial structure: 10 of 12 (83.3%) were located around the left atrial appendage and ridge. Flutter wave, GAH score ≤ 0.05, and GAH score < 0.1 for >110 ms of cycle length differentiated true-focal from pseudo-focal with a sensitivity/negative predictive value of 100%. GAH score < 0.1 for >40% of the cycle length simply discriminated true-focal from pseudo-focal with 100% accuracy. CONCLUSION Centrifugal activation is not necessarily due to a focal AT but passive activation. The activation map with GAH in addition to the 12-lead electrocardiogram and local electrograms enables an accurate differentiation.
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Ma W, Qiu J, Lu F, Shehata M, Wang X, Wu D, He L, Xu J. Catheter ablation for atrial tachycardias: How to interpret the unclear activation map? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:274-283. [PMID: 32990323 DOI: 10.1111/pace.14083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-ablation atrial tachycardias (ATs) are characterized by low-voltage signals that challenge current mapping methods. In this study, we analyzed common mistakes during activation mapping and delineated a mapping strategy for correct interpretation of tachycardia mechanisms in patients with challenging underlying substrate. METHODS AND RESULTS Thirty-one patients referred for AT ablation were selected for the study. Three types of incorrect activation patterns were identified, which were referred to as unrecognized block line (pseudo-macroreentry and pseudo-fig-8 reentry), incorrect activation timing window of interest (WOI) (chaotic activation), and mis-annotation of complex signals (multiple sites of "early meets late"). Pseudo-macroreentry and chaotic activation occur in focal or localized reentry AT with the error related to the WOI selection (four cases), incorrect annotation of local activation time (six cases), or a previous line of atrial block in (seven cases). Pseudo-fig-8 reentry (five cases) and multiple sites of "early meets late" (nine cases) occur in macroreentrant AT with blocked areas and low-voltage atrial substrate. All ATs were successfully eliminated at the origin site. CONCLUSIONS We delineated a series of ATs in the setting of a disordered pattern of activation mapping encountered in patients after previous extensive ablation or atriotomy. The algorithm proposed rapidly corrects the activation map and identifies the mechanism of the AT.
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Affiliation(s)
- Wei Ma
- Heart Rhythm Center, Heart Institute, Tianjin Chest Hospital, Tianjin, China
| | - Jiuchun Qiu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Fengmin Lu
- Heart Rhythm Center, Heart Institute, Tianjin Chest Hospital, Tianjin, China
| | | | - Xunzhang Wang
- Cedars Sinai Medical Center, Los Angeles, California
| | - Dongyan Wu
- Heart Rhythm Center, Heart Institute, Tianjin Chest Hospital, Tianjin, China
| | - Le He
- Heart Rhythm Center, Heart Institute, Tianjin Chest Hospital, Tianjin, China
| | - Jing Xu
- Heart Rhythm Center, Heart Institute, Tianjin Chest Hospital, Tianjin, China
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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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Kumagai K. Editorial to utility of directional high-density mapping catheter (Advisor HD Grid) in complex scar-related atrial tachycardia. J Arrhythm 2020; 36:184-185. [PMID: 32071640 PMCID: PMC7011816 DOI: 10.1002/joa3.12272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Koji Kumagai
- Department of Cardiovascular MedicineTohoku Medical and Pharmaceutical UniversityMiyagiJapan
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