Electrophysiologic Determinants of Isoelectric Intervals on Surface Electrocardiograms During Atrial Tachycardia: Insights From High-Density Mapping.
P-wave
atrial tachycardia
electroanatomic mapping
electrocardiogram
re-entry
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
03
01
2023
revised:
14
06
2023
accepted:
25
06
2023
medline:
27
10
2023
pubmed:
16
9
2023
entrez:
16
9
2023
Statut:
ppublish
Résumé
Substrate abnormalities can alter atrial activation during atrial tachycardias (ATs) thereby influencing AT-wave morphology on the surface electrocardiogram. This study sought to identify determinants of isoelectric intervals during ATs with complex atrial activation patterns. High-density activation maps of 126 ATs were studied. To assess the impact of the activated atrial surface on the presence of isoelectric intervals, this study measured the minimum activated area throughout the AT cycle, defined as the smallest activated area within a 50-millisecond period, by using signal processing algorithms (LUMIPOINT). ATs with isoelectric intervals (P-wave ATs) included 23 macro-re-entrant ATs (40%), 26 localized-re-entrant ATs (46%), and 8 focal ATs (14%), whereas those without included 46 macro-re-entrant ATs (67%), 21 localized-re-entrant ATs (30%), and 2 focal ATs (3%). Multivariable regression identified smaller minimum activated area and larger very low voltage area as independent predictors of P-wave ATs (OR: 0.732; 95% CI: 0.644-0.831; P < 0.001; and OR: 1.042; 95% CI: 1.006-1.080; P = 0.023, respectively). The minimum activated area with the cutoff value of 10 cm Reduced atrial activation area and voltage were associated with isoelectric intervals during ATs.
Sections du résumé
BACKGROUND
Substrate abnormalities can alter atrial activation during atrial tachycardias (ATs) thereby influencing AT-wave morphology on the surface electrocardiogram.
OBJECTIVES
This study sought to identify determinants of isoelectric intervals during ATs with complex atrial activation patterns.
METHODS
High-density activation maps of 126 ATs were studied. To assess the impact of the activated atrial surface on the presence of isoelectric intervals, this study measured the minimum activated area throughout the AT cycle, defined as the smallest activated area within a 50-millisecond period, by using signal processing algorithms (LUMIPOINT).
RESULTS
ATs with isoelectric intervals (P-wave ATs) included 23 macro-re-entrant ATs (40%), 26 localized-re-entrant ATs (46%), and 8 focal ATs (14%), whereas those without included 46 macro-re-entrant ATs (67%), 21 localized-re-entrant ATs (30%), and 2 focal ATs (3%). Multivariable regression identified smaller minimum activated area and larger very low voltage area as independent predictors of P-wave ATs (OR: 0.732; 95% CI: 0.644-0.831; P < 0.001; and OR: 1.042; 95% CI: 1.006-1.080; P = 0.023, respectively). The minimum activated area with the cutoff value of 10 cm
CONCLUSIONS
Reduced atrial activation area and voltage were associated with isoelectric intervals during ATs.
Identifiants
pubmed: 37715740
pii: S2405-500X(23)00566-2
doi: 10.1016/j.jacep.2023.06.018
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2054-2066Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures This research was partly funded by a grant from Investissement d’avenir: IHU LIRYC ANR-10-IAHU-04. Ms Carapezzi is an employee of Boston Scientific. Dr Jaïs has received speaking honoraria and consulting fees from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.