Peak frequency mapping of atypical atrial flutter.
atypical atrial flutter
cardiac mapping
catheter ablation
electroanatomic mapping
signal processing
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
13 Mar 2024
13 Mar 2024
Historique:
revised:
05
02
2024
received:
06
10
2023
accepted:
09
02
2024
medline:
13
3
2024
pubmed:
13
3
2024
entrez:
13
3
2024
Statut:
aheadofprint
Résumé
Peak frequency (PF) mapping is a novel method that may identify critical portions of myocardial substrate supporting reentry. The aim of this study was to describe and evaluate PF mapping combined with omnipolar voltage mapping in the identification of critical isthmuses of left atrial (LA) atypical flutters. LA omnipolar voltage and PF maps were generated in flutter using the Advisor HD-Grid catheter (Abbott) and EnSite Precision Mapping System (Abbott) in 12 patients. Normal voltage was defined as ≥0.5 mV, low-voltage as 0.1-0.5 mV, and scar as <0.1 mV. PF distributions were compared with ANOVA and post hoc Tukey analyses. The 1 cm radius from arrhythmia termination was compared to global myocardium with unpaired t-testing. The mean age was 65.8 ± 9.7 years and 50% of patients were female. Overall, 34 312 points were analyzed. Atypical flutters most frequently involved the mitral isthmus (58%) or anterior wall (25%). Mean PF varied significantly by myocardial voltage: normal (335.5 ± 115.0 Hz), low (274.6 ± 144.0 Hz), and scar (71.6 ± 140.5 Hz) (p < .0001 for all pairwise comparisons). All termination sites resided in low-voltage regions containing intermediate or high PF. Overall, mean voltage in the 1 cm radius from termination was significantly lower than the remaining myocardium (0.58 vs. 0.95 mV, p < .0001) and PF was significantly higher (326.4 vs. 245.1 Hz, p < .0001). Low-voltage, high-PF areas may be critical targets during catheter ablation of atypical atrial flutter.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Abbott Laboratories
Organisme : Duke University
Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
Bun SS, Latcu DG, Marchlinski F, Saoudi N. Atrial flutter: more than just one of a kind. Eur Heart J. 2015;36:2356-2363.
Chae S, Oral H, Good E, et al. Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation. J Am Coll Cardiol. 2007;50:1781-1787.
Derval N, Takigawa M, Frontera A, et al. Characterization of complex atrial tachycardia in patients with previous atrial interventions using high-resolution mapping. JACC: Clin Electrophysiol. 2020;6:815-826.
Jaïs P, Shah DC, Haïssaguerre M, et al. Mapping and ablation of left atrial flutters. Circulation. 2000;101:2928-2934.
Coffey JO, d'Avila A, Dukkipati S, et al. Catheter ablation of scar-related atypical atrial flutter. EP Europace. 2013;15:414-419.
Ouyang F, Ernst S, Vogtmann T, et al. Characterization of reentrant circuits in left atrial macroreentrant tachycardia. Circulation. 2002;105:1934-1942.
Schaeffer B, Stevenson WG. Entrainment mapping: theoretical considerations and practical implementation. J Cardiovasc Electrophysiol. 2018;29:204-213.
Johner N, Shah DC, Jousset F, Dall'aglio PB, Namdar M. Electrophysiological and anatomical correlates of sites with postpacing intervals shorter than tachycardia cycle length in atypical atrial flutter. Circulation. Arrhythmia Electrophysiol. 2019;12:e006955.
Nayak HM, Aziz ZA, Kwasnik A, et al. Indirect and direct evidence for 3-D activation during left atrial flutter. JACC: Clin Electrophysiol. 2020;6:1812-1823.
Deno DC, Balachandran R, Morgan D, Ahmad F, Masse S, Nanthakumar K. Orientation-independent catheter-based characterization of myocardial activation. IEEE Trans Biomed Eng. 2017;64:1067-1077.
Massé S, Magtibay K, Jackson N, et al. Resolving myocardial activation with novel omnipolar electrograms. Circulation. Arrhythmia Electrophysiol. 2016;9:e004107.
Karatela MF, Dowell RS, Friedman DJ, Jackson KP, Piccini JP. Omnipolar versus bipolar electrode mapping in patients with atrial fibrillation undergoing catheter ablation. JACC: Clin Electrophysiol. 2022;8:1539-1552.
D'agostino RB, Belanger A, D'agostino Jr. RB. A suggestion for using powerful and informative tests of normality. Am Stat. 1990;44:316-321.
R Core Team. R: A Language and Environment for Statistical Computing [computer program]. R Foundation for Statistical Computing; 2021.
Markowitz SM, Thomas G, Liu CF, Cheung JW, Ip JE, Lerman BB. Approach to catheter ablation of left atrial flutters. J Cardiovasc Electrophysiol. 2019;30:3057-3067.
Pott A, Teumer Y, Weinmann K, et al. Substrate-based ablation of atypical atrial flutter in patients with atrial cardiomyopathy. Int J Cardiol Heart Vasc. 2022;40:101018.
Yu J, Chen K, Yang B, et al. Peri-mitral atrial flutter: personalized ablation strategy based on arrhythmogenic substrate. EP Europace. 2018;20:835-842.
Sundaram S, Choe W, Ryan Jordan J, et al. Catheter ablation of atypical atrial flutter: a novel 3D anatomic mapping approach to quickly localize and terminate atypical atrial flutter. J Interv Card Electrophysiol. 2017;49:307-318.
Shah D, Sunthorn H, Burri H, et al. Narrow, slow-conducting isthmus dependent left atrial reentry developing after ablation for atrial fibrillation: ECG characterization and elimination by focal RF ablation. J Cardiovasc Electrophysiol. 2006;17:508-515.
Winkle RA, Moskovitz R, Mead RH, et al. Ablation of atypical atrial flutters using ultra high density-activation sequence mapping. J Interv Card Electrophysiol. 2017;48:177-184.
Kapur S. Atypical flutter with atrial isochronal late-activation map correlating with the critical isthmus. J Innovations Cardiac Rhythm Manag. 2020;12:20-21.
Woods CE, Schricker AA, Nayak H, et al. Correlation between sinus rhythm deceleration zones and critical sites for localized reentrant atrial flutter: a retrospective multicenter analysis. Heart Rhythm O2. 2022;3:279-287.
Tung S, Soejima K, Maisel WH, Suzuki M, Epstein L, Stevenson WG. Recognition of far-field electrograms during entrainment mapping of ventricular tachycardia. J Am Coll Cardiol. 2003;42:110-115.
Munoz FDC, Buescher TL, Asirvatham SJ. Teaching points with 3-dimensional mapping of cardiac arrhythmia. Circulation: Arrhythmia Electrophysiol. 2011;4:e1-e3.
Baldinger SH, Nagashima K, Kumar S, et al. Electrogram analysis and pacing are complimentary for recognition of abnormal conduction and far-field potentials during substrate mapping of infarct-related ventricular tachycardia. Circulation. Arrhythmia Electrophysiol2015;8:874-881.