Selection of Critical Isthmus in Scar-Related Atrial Tachycardia Using a New Automated Ultrahigh 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.

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Termination of the left atrial tachycardia by the ablation of epicardial critical isthmus visualized with a novel high-resolution mapping system

Clinical Research in Cardiology ◽

10.1007/s00392-016-1030-9 ◽

2016 ◽

Vol 105 (12) ◽

pp. 1049-1050 ◽

Cited By ~ 5

Author(s):

Jedrzej Kosiuk ◽

Frank Lindemann ◽

Gehard Hindricks ◽

Andreas Bollmann

Keyword(s):

High Resolution ◽

Left Atrial ◽

Atrial Tachycardia ◽

High Resolution Mapping ◽

Mapping System ◽

Resolution Mapping

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Characteristics of Single-Loop Macroreentrant Biatrial Tachycardia Diagnosed by Ultrahigh-Resolution Mapping System

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.117.005558 ◽

2018 ◽

Vol 11 (2) ◽

Cited By ~ 24

Author(s):

Takeshi Kitamura ◽

Ruairidh Martin ◽

Arnaud Denis ◽

Masateru Takigawa ◽

Alexandre Duparc ◽

...

Keyword(s):

Ultrahigh Resolution ◽

Single Loop ◽

Mapping System ◽

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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Characteristics of Marshall bundle-related atrial tachycardias using an ultrahigh-resolution mapping system

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-019-00544-9 ◽

2019 ◽

Vol 55 (2) ◽

pp. 161-169 ◽

Cited By ~ 2

Author(s):

Iwanari Kawamura ◽

Seiji Fukamizu ◽

Marina Arai ◽

Dai Inagaki ◽

Tomonori Miyabe ◽

...

Keyword(s):

Ultrahigh Resolution ◽

Mapping System ◽

Resolution Mapping

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P957Characteristics of atrial tachycardia after mitral surgey via biatrial trans-septal approach using high density mapping system

EP Europace ◽

10.1093/europace/euaa162.222 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Cataldi ◽

M Andronache ◽

R Eschalier ◽

F Jean ◽

R Bosle ◽

...

Keyword(s):

Atrial Tachycardia ◽

Sinus Node ◽

Pulmonary Veins ◽

High Density ◽

Congenital Defects ◽

Density Mapping ◽

Mapping System ◽

Oblique Incision ◽

Pace Maker ◽

The Right

Abstract Background The biatrial trans-septal approach (BTSa) ameliorates mitral valve (MV) exposure in difficult cases when routine left atriotomy doesnt"t allow it. Main steps are an oblique incision on the right atrium (RA), reaching medially the right pulmonary veins (PV), a septal incision from the fossa ovalis, extended up to reach the first incision, then on the left atrium (LA). Purpose We aim to study the arrhythmic burden in this post-surgical context, focusing on atrial tachycardia (AT), to investigate the complexity of several possible circuits. Methods All patients (>18yo) with previous MV surgery via BTSa for MV repair or replacement, who underwent ablation of AT from January 2017 to September 2019, were enrolled. Patients ablated for persistent or paroxysmal AF, or with AF during the index procedure were excluded. Patients with associated surgery on other valves or congenital defects, coronary, surgical or percutaneous rhythm interventions weren’t excluded. Electroanatomical mapping was created using 2 different high-density mapping system. Substrate and activation map and radio-frequency (RF) ablation (25-50W, Ablation Index target 400) were realized. Cartographies were analysed to evaluate AT re-entry circuit, critical isthmus (CI) location and characterization, atrial vulnerability. Procedural outcomes (AT termination, sinus rhythm (SR) restoration, anti-arrhythmic drugs (AAD) withdrawal), and peri-procedural complications were also evaluated. Results We enrolled 49 patients (median age 57 ± 15), finding a maximum of 5 AT per procedure (2 ± 1). A total of 112 AT were mapped: the majority (72%) were persistent AT, 8,2% common atrial flutter. Cycle length was 314 ± 74 msec, with proximal-distal activation of coronary sinus (78%). A multiple re-entry circuit was observed in 70% of index AT. We identified 152 critical isthmus (maximum 5 per procedure). Only 27,9% of our patients had a single CI; CTI was the most frequent one (n = 37), envolved in 33% of all AT, while BTS scars altogether were envolved in 65% AT. A complete AT circuit was mapped in the RA, the LA and both atria in respectively 49%, 11,5% and 39%AT. The distribution of CIs is shown in figure 1. Biatrial and left AT leads to superior procedure, RF and fluoroscopy duration (p <0,05). SR was restored in 93,4%of patients, requiring a DC shock in 4 cases. Immediate AAD withdrawal was achieved after 41%procedures. No pericardial, oesophageal, vascular or phrenic complication occurred. 4 pace-maker implantations were realized because of 3 interatrial, 2 AV block and a sinus node dysfunction. Conclusions AT occurring after a BTSa have a high prevalence of multiple re-entry circuits with multiple critical isthmus. Ablation in this context is feasible and safe but often requires a left atrial access. Mapping of both atria should be considered to identify critical isthmus and tailored ablation strategy. Abstract Figure 1. Critical Isthmus Distribution

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Comparison between new confidense HD coloring cartomapping module and new rhythmia mapping system for scar related atrial tachycardia treatment. A prospective randomised study: Preliminary results

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2020.10.200 ◽

2021 ◽

Vol 13 (1) ◽

pp. 88

Author(s):

N. Vidal ◽

A. Da Costa ◽

C. Romeyer ◽

J.B. Guichard ◽

A. Gate-Martinet ◽

...

Keyword(s):

Atrial Tachycardia ◽

Randomised Study ◽

Preliminary Results ◽

Mapping System ◽

Prospective Randomised Study

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The use of a high-resolution mapping system may facilitate standard clinical practice in VE and VT ablation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-019-00530-1 ◽

2019 ◽

Vol 55 (3) ◽

pp. 287-295

Author(s):

Arian Sultan ◽

Barbara Bellmann ◽

Jakob Lüker ◽

Tobias Plenge ◽

Jan-Hendrik van den Bruck ◽

...

Keyword(s):

Clinical Practice ◽

High Resolution ◽

High Resolution Mapping ◽

Standard Clinical Practice ◽

Mapping System ◽

Resolution Mapping ◽

Vt Ablation

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Micro-reentry right atrial tachycardia originating from fossa ovalis: a case report of high-density mapping by PentaRay catheter

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz141 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Jin-Yi Li ◽

Xiang-Wei Lv ◽

Guo-Qiang Zhong ◽

Hong-Hong Ke

Keyword(s):

Atrial Tachycardia ◽

Mapping Method ◽

High Density ◽

Right Atrial ◽

Ablation Therapy ◽

Density Mapping ◽

Mapping System ◽

Conventional Mapping ◽

Electrophysiological Examination

Abstract Background Micro-reentry tachycardia usually emerges in scar tissues related to post-atrial fibrillation ablation and cardiomyopathy. It is difficult to identify the micro-reentry circuit accurately by conventional mapping method. Case summary A 74-year-old man presented with paroxysmal atrial tachycardia (AT) presenting as palpitations. He was evaluated by an electrophysiological examination using a high-density CARTO mapping system. The mapping results showed the AT with a cycle length of 184 ms was focused on his right atrial fossa ovalis (FO). In this small area, the high-density mapping demonstrated a significant micro-reentrant tachycardia. Radiofrequency ablation at the centre of the micro-reentrant circuit successfully terminated the AT. No recurrences were observed during a 12-month follow-up. Discussion This case demonstrated a micro-reentrant AT originates from the FO without cardiomyopathy or previous ablation with specific loops. This is an unusual location for AT though and can cause difficulty for operators if it terminates or is non-sustained. High-density mapping using a PentaRay catheter can effectively characterize micro-reentrant circuits and determine the real target for ablation therapy.

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