A simple mechanism underlying the behavior of reentrant atrial tachycardia during ablation.

Algorithms Catheter Ablation Electrophysiologic Techniques, Cardiac Female Heart Conduction System / physiopathology Humans Male Middle Aged Retrospective Studies Tachycardia, Atrioventricular Nodal Reentry / classification

Catheter ablation High-resolution mapping system Multiple loop atrial tachycardia Reentrant tachycardia

Journal

Heart rhythm

ISSN: 1556-3871

Titre abrégé: Heart Rhythm

Pays: United States

ID NLM: 101200317

Informations de publication

Date de publication:
04 2019

Historique:

received: 19 09 2018

pubmed: 6 11 2018

medline: 6 10 2020

entrez: 4 11 2018

Statut: ppublish

Résumé

Ablation of complex atrial tachycardias (ATs) is difficult. The purpose of this study was to elucidate a mechanism underlying the behavior of ATs during ablation and to create an algorithm to predict it. An algorithm predicting termination/conversion of AT and the second AT circuit associated with the ablation site was developed from 52 index reentrant AT high-resolution activation maps in 45 patients (retrospective phase). First, the wavefront collision site was identified. Then, the N or N-1 beat was defined for each collision associated with the ablation site. When the AT involved wavefront collision solely between N-1/N-1 (N/N) beats, the AT would terminate during ablation. Conversely, when the AT included wavefront collision between N/N-1 beats, the index AT would convert to a second AT. The algorithm was then prospectively tested in 172 patients with 194 ATs (127 anatomic macroreentrant ATs [AMATs], 44 non-AMATs, 23 multiple-loop ATs). Accuracy in predicting AT termination/conversion and the second AT circuit was 95.9% overall, 96.1% in AMATs, 95.5% in non-AMATs, and 95.7% in multiple-loop ATs. Median (25th-75th percentile) absolute variation between predicted and actually observed cycle length of the second AT was 6 (4-9) ms. Prediction failure occurred in 8 ATs; either the second AT used an unmapped chamber or structure in the index map (n = 7) or a line of block was misinterpreted as very slow conduction in the index map (n = 1). A simple mechanism underlies the behavior of ATs during ablation, even in complex ATs. With a simple algorithm using high-resolution mapping, AT termination/conversion and the second AT circuit and cycle length may be predicted from the index activation map.

Sections du résumé

BACKGROUND

Ablation of complex atrial tachycardias (ATs) is difficult.

OBJECTIVE

The purpose of this study was to elucidate a mechanism underlying the behavior of ATs during ablation and to create an algorithm to predict it.

METHODS

An algorithm predicting termination/conversion of AT and the second AT circuit associated with the ablation site was developed from 52 index reentrant AT high-resolution activation maps in 45 patients (retrospective phase). First, the wavefront collision site was identified. Then, the N or N-1 beat was defined for each collision associated with the ablation site. When the AT involved wavefront collision solely between N-1/N-1 (N/N) beats, the AT would terminate during ablation. Conversely, when the AT included wavefront collision between N/N-1 beats, the index AT would convert to a second AT. The algorithm was then prospectively tested in 172 patients with 194 ATs (127 anatomic macroreentrant ATs [AMATs], 44 non-AMATs, 23 multiple-loop ATs).

RESULTS

Accuracy in predicting AT termination/conversion and the second AT circuit was 95.9% overall, 96.1% in AMATs, 95.5% in non-AMATs, and 95.7% in multiple-loop ATs. Median (25th-75th percentile) absolute variation between predicted and actually observed cycle length of the second AT was 6 (4-9) ms. Prediction failure occurred in 8 ATs; either the second AT used an unmapped chamber or structure in the index map (n = 7) or a line of block was misinterpreted as very slow conduction in the index map (n = 1).

CONCLUSION

A simple mechanism underlies the behavior of ATs during ablation, even in complex ATs. With a simple algorithm using high-resolution mapping, AT termination/conversion and the second AT circuit and cycle length may be predicted from the index activation map.

Identifiants

DOI: 10.1016/j.hrthm.2018.10.031 PMID: 30389441

pubmed: 30389441

pii: S1547-5271(18)31117-2

doi: 10.1016/j.hrthm.2018.10.031

pii:

doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

553-561

Commentaires et corrections

Type : CommentIn