How to map and ablate a pulmonary vein–to–right atrium breakthrough during simultaneous persistent pulmonary vein fibrillation and organized atrial fibrillation using an automated high-resolution mapping system

Aims The circuit of pulmonary vein-gap re-entrant atrial tachycardia (PV-gap RAT) after atrial fibrillation ablation is sometimes difficult to identify by conventional mapping. We analysed the detailed circuit and electrophysiological features of PV-gap RATs using a novel high-resolution mapping system. Methods and results This multicentre study investigated 27 (7%) PV-gap RATs in 26 patients among 378 atrial tachycardias (ATs) mapped with Rhythmia™ system in 281 patients. The tachycardia cycle length (TCL) was 258 ± 52 ms with P-wave duration of 116 ± 28 ms. Three types of PV-gap RAT circuits were identified: (A) two gaps in one pulmonary vein (PV) (unilateral circuit) (n = 17); (B) two gaps in the ipsilateral superior and inferior PVs (unilateral circuit) (n = 6); and (C) two gaps in one PV with a large circuit around contralateral PVs (bilateral circuit) (n = 4). Rhythmia™ mapping demonstrated two distinctive entrance and exit gaps of 7.6 ± 2.5 and 7.9 ± 4.1 mm in width, respectively, the local signals of which showed slow conduction (0.14 ± 0.18 and 0.11 ± 0.10m/s) with fragmentation (duration 86 ± 27 and 78 ± 23 ms) and low-voltage (0.17 ± 0.13 and 0.17 ± 0.21 mV). Twenty-two ATs were terminated (mechanical bump in one) and five were changed by the first radiofrequency application at the entrance or exit gap. Moreover, the conduction time inside the PVs (entrance-to-exit) was 138 ± 60 ms (54 ± 22% of TCL); in all cases, this resulted in demonstrating P-wave with an isoelectric line in all leads. Conclusion This is the first report to demonstrate the detailed mechanisms of PV-gap re-entry that showed evident entrance and exit gaps using a high-resolution mapping system. The circuits were variable and Rhythmia™-guided ablation targeting the PV-gap can be curative.

Download Full-text

Cryoballoon left atrial roof ablation for persistent atrial fibrillation ∼Analysis with high‐resolution mapping system∼

Pacing and Clinical Electrophysiology ◽

10.1111/pace.14345 ◽

2021 ◽

Author(s):

Shinsuke Miyazaki ◽

Kanae Hasegawa ◽

Moe Mukai ◽

Daisetsu Aoyama ◽

Minoru Nodera ◽

...

Keyword(s):

Atrial Fibrillation ◽

High Resolution ◽

Left Atrial ◽

Persistent Atrial Fibrillation ◽

High Resolution Mapping ◽

Mapping System ◽

Resolution Mapping

Download Full-text

Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-020-00808-9 ◽

2020 ◽

Author(s):

Robbert Ramak ◽

Gian-Battista Chierchia ◽

Gaetano Paparella ◽

Cinzia Monaco ◽

Vincenzo Miraglia ◽

...

Keyword(s):

Atrial Fibrillation ◽

High Resolution ◽

Charge Density ◽

Pulmonary Vein ◽

The Novel ◽

Mapping Algorithm ◽

Af Ablation ◽

High Resolution Mapping ◽

Resolution Mapping ◽

The Mean

Abstract Purpose The purpose of this study was to evaluate the safety and feasibility of the new high-resolution mapping algorithm SuperMap (Acutus Medical, CA, USA) in identifying and guiding ablation in the setting of regular atrial tachycardias following index atrial fibrillation (AF) ablation. Methods Seven consecutive patients who underwent a radiofrequency catheter ablation guided by the novel noncontact charge density (CD) SuperMap for atrial tachycardia were prospectively enrolled in our study. Results Arrhythmogenic substrate was identified in all seven patients. Mean number of EGM per map was 5859.7 ± 4348.5 points. Three patients (43%) exhibited focal tachycardia mechanisms in the left atrium, alternating from anteroseptal right superior pulmonary vein (RSPV), posterior in proximity of left inferior pulmonary vein (LIPV), and interarial septum in proximity of fossa ovalis, respectively. Four patients exhibited macroreentrant mechanism. In 3 of these patients, SuperMap detected mitral isthmus-dependent flutters with tachycardia cycle lengths of 240, 270 and 420 ms, respectively. In one patient, the mechanism was a macroreentrant tachycardia with the critical isthmus located between the crista terminalis and atriotomy. The mean ablation time (min) was 18.2 ± 12.5 and the mean procedural duration time was 56.4 ± 12.1 min. No minor or major complications occurred. Conclusion The novel high-resolution mapping algorithm SuperMap proved to be safe, fast, and feasible in identifying and guiding ablation in the setting of regular atrial tachycardias following index AF ablation.

Download Full-text