P5757Mapping and ablation of complex left atrial tachycardia using an automated high resolution mapping algorithm

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.

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Pulmonary vein-gap re-entrant atrial tachycardia following atrial fibrillation ablation: an electrophysiological insight with high-resolution mapping

EP Europace ◽

10.1093/europace/euz034 ◽

2019 ◽

Vol 21 (7) ◽

pp. 1039-1047 ◽

Cited By ~ 2

Author(s):

Seigo Yamashita ◽

Masateru Takigawa ◽

Arnaud Denis ◽

Nicolas Derval ◽

Yuichiro Sakamoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

High Resolution ◽

Pulmonary Vein ◽

Atrial Tachycardia ◽

Atrial Fibrillation Ablation ◽

P Wave ◽

Conduction Time ◽

High Resolution Mapping ◽

Mapping System ◽

Resolution Mapping

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.

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Characterization of Complex Atrial Tachycardia in Patients With Previous Atrial Interventions Using High-Resolution Mapping

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2020.03.004 ◽

2020 ◽

Vol 6 (7) ◽

pp. 815-826

Author(s):

Nicolas Derval ◽

Masateru Takigawa ◽

Antonio Frontera ◽

Saagar Mahida ◽

Vlachos Konstantinos ◽

...

Keyword(s):

High Resolution ◽

Atrial Tachycardia ◽

High Resolution Mapping ◽

Resolution Mapping

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Effects of procainamide on electrical activity in thoracic veins and atria in canine model of sustained atrial fibrillation

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00754.2003 ◽

2004 ◽

Vol 286 (5) ◽

pp. H1936-H1945 ◽

Cited By ~ 26

Author(s):

Chung-Chuan Chou ◽

Shengmei Zhou ◽

Yasushi Miyauchi ◽

Hui-Nam Pak ◽

Yuji Okuyama ◽

...

Keyword(s):

Atrial Fibrillation ◽

High Resolution ◽

Cumulative Dose ◽

Refractory Period ◽

Atrial Tachycardia ◽

Canine Model ◽

Dominant Frequency ◽

Wave Fronts ◽

High Resolution Mapping ◽

Resolution Mapping

Focal discharges (FDs) are present in thoracic veins during atrial fibrillation (AF). We hypothesize that procainamide exerts its anti-AF action by suppressing FDs in the thoracic veins. We studied six mongrel dogs (22–27 kg) with sustained (>6 h) AF induced by 47 ± 20 days of chronic rapid LA appendage (LAA) or pulmonary vein (PV) pacing. Procainamide was infused intravenously until AF was terminated or a cumulative dose of 20 mg/kg was reached. High-resolution mapping during AF showed FDs in the vein of Marshall, PVs, and the LAA. Procainamide significantly ( P < 0.05) reduced the frequency of these FDs and suppressed the interactions of wave fronts between PVs and LA. The cumulative dose of PA needed to terminate AF correlated negatively ( r =–0.9, P < 0.05) with the baseline effective refractory period (ERP) of PV and positively ( r = 0.8, P < 0.05) with the baseline maximum dominant frequency (DF) of AF. In four of five dogs, AF converted to atrial tachycardia originating from the PVs before termination. Attempts to reinduce sustained AF were unsuccessful in these five dogs. AF was resistant to procainamide in the sixth dog. In conclusion, procainamide reduced the rate of FDs in the thoracic veins and the LA and suppressed the interaction between PVs and LA. Second, FDs in the PV are more resistant to procainamide's action than FDs in the atria. Third, inherent PV ERP is important in determining the antifibrillatory efficacy of procainamide.

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A postsurgery atrial tachycardia with alternating cycle length: The possible circuits revealed by high-resolution mapping

HeartRhythm Case Reports ◽

10.1016/j.hrcr.2019.05.005 ◽

2020 ◽

Vol 6 (6) ◽

pp. 297-299

Author(s):

Dongchen Zhou ◽

Wei Hu ◽

Gang Yang ◽

Hongwu Chen ◽

Biqi Zhang ◽

...

Keyword(s):

High Resolution ◽

Cycle Length ◽

Atrial Tachycardia ◽

High Resolution Mapping ◽

Resolution Mapping

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P6565The relation between the variation of CL and atrial tachycardia

European Heart Journal ◽

10.1093/eurheartj/ehz746.1155 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M T Takigawa ◽

C A Andre ◽

A L Lam ◽

W E Escande ◽

Y N Nakatani ◽

...

Keyword(s):

High Resolution ◽

Coronary Sinus ◽

Cycle Length ◽

Atrial Tachycardia ◽

Correct Diagnosis ◽

High Resolution Mapping ◽

Mapping System ◽

Resolution Mapping ◽

The Right ◽

The Relationship

Abstract Background Complex ATs with a complicated circuit have been increasing because of the native or iatrogenic scars in atrium. However, development of resolution in the EAM allows us to reach the correct diagnosis. The purpose of this study was to reassess the relationship between characteristics of ATs and cycle length based on the correct diagnosis with high-resolution mapping system. Method Among 85 consecutive AT patients treated with with high-resolution mapping system “Rhythmia”, patients with at least one mappable AT during procedure were prospectively included in this study. Maximal, minimal, and variation of ATCL was calculated from the decapolar in the coronary sinus (CS) during 2minutes, and the relation between CL and respiration was measured on the Rhythmia (Figure 1). These values were compared to AT types. Results 90 ATs in 65 patients (mean 59±13 yrs, 16 females, 55 post-AF ATs) including 4 focal-ATs, 23 localized-AT, and 63 macroreentrant ATs were analyzed. As shown in the table 1, the maximum and minimum CL was similar between focal-AT, localized-AT, and, macroreentrant-AT. However, both absolute CL-variation and ratio of CL-variation were significantly smaller in macroreentrant ATs (P=0.009 and P=0.0012, respectively). Table 2 described the comparison between 66 left-ATs and 24 right-ATs. Although the maximum and minimum CL were similar, both absolute CL-variation and ratio of CL-variation were significantly larger in right ATs (P=0.001 and P=0.007, respectively). Additionally, the correlation of CL to the respiration was significantly more frequently seen in the right-ATs (3.0% in left-ATs and 62.5% in right-ATs, P<0.0001). Table 1, 2 and Figure 1 Conclusions CL-variation of ATs may be significantly smaller in macroreentrant ATs and significantly larger in right ATs. CL-variation correlated to the respiration may suggest right-ATs. These information may be helpful to diagnose ATs before mapping.

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