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Jungen C, Akbulak R, Kahle A, Eickholt C, Schaeffer B, Dinshaw L, Schleberger R, Nies M, Gunawardene M, Muenkler P, Klatt N, Hartmann J, Jularic M, Willems S, Meyer C. Outcome after practical isthmus ablation of scar-related atrial tachycardia guided by high-density mapping. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
High-density mapping (HDM) has been found to precisely identify the practical isthmus of scar-related atrial tachycardia (AT) circuits. Since practical isthmuses have been found to be shorter than the usual anatomical isthmuses targeted ablation has been proposed. However, outcome data are sparse. Here we describe HDM-guided catheter ablation by targeting the practical isthmus in patients with scar-related ATs.
Methods and results
In 250 consecutive patients with scar-related ATs HDM-guided catheter ablation with the support of a 64-electrode mini-basket catheter has been performed. Most patients underwent a prior catheter ablation (98%) while 13% had a prior cardiac valve surgery and 6% an underlying congenital heart disease. A total of 355 ATs occurred in the index procedure, of which 64% had a macro-, 26% a micro-reentry and 10% a focal mechanism. The ATs had a mean cycle length of 304±4.3 ms and in 237 patients (95%) an acute termination into sinus rhythm was achieved. They were mainly located in the left atrium (72%) but also in the right atrium (25%), bi-atrially (5%) or in the CS (3%) (see figure). Targeting the practical isthmus revealed arrhythmia freedom in 53% of patients after a single procedure during a mid-term follow-up (median 489 days, range 95–1407 days). Freedom from any arrhythmia could be achieved in 74% of patients after multiple procedures and in 93% of patients after multiple procedures and optimal clinical therapy, including pharmaceutical or electrical cardioversion.
Conclusions
HDM-guided catheter ablation of the practical isthmus in patients with scar-related ATs leads to a high acute success rate. Nevertheless, multiple procedures are necessary in a relevant number of patients resulting in a low recurrence rate.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Jungen
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - R Akbulak
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Kahle
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - C Eickholt
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Schaeffer
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - L Dinshaw
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - R Schleberger
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - M Nies
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - M Gunawardene
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - P Muenkler
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - J Hartmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - M Jularic
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
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Jungen C, Kuklik P, Eickholt C, Akbulak R, Klatt N, Hartmann J, Gunawardene M, Geisler A, Jularic M, Klene C, Klutmann S, Willems S, Mester J, Meyer C. 3012Ventricular arrhythmia ablation in areas of mismatch between sympathetic innervation and electroanatomical voltage. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Jungen
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - P Kuklik
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - C Eickholt
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - R Akbulak
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - J Hartmann
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - M Gunawardene
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - A Geisler
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - M Jularic
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - C Klene
- University Medical Center Hamburg Eppendorf, Department of Nuclear Medicine, Hamburg, Germany
| | - S Klutmann
- University Medical Center Hamburg Eppendorf, Department of Nuclear Medicine, Hamburg, Germany
| | - S Willems
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - J Mester
- University Medical Center Hamburg Eppendorf, Department of Nuclear Medicine, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
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Moser J, Schaeffer B, Akbulak R, Nuerich J, Eickholt C, Jularic M, Willems S, Hoffmann B. P804Sedation monitoring with processed electroencephalogram signals under propofol sedation: a potential benefit on mapping and catheter ablation of ventricular premature contractions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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