Atrial Tachycardias After Atrial Fibrillation Ablation Manifest Different Waveform Characteristics: Implications for Characterizing Tachycardias

Abstract

INTRODUCTON Atrial fibrillation (AF) ablation patients often manifest atrial tachycardias (AT) with atypical ECG morphologies that preclude accurate localization and mechanism. Diagnostic maneuvers used to define ATs during electrophysiology studies can be limited by tachycardia termination or transformation. Additional methods of characterizing post-AF ablation ATs are required. METHODS AND RESULTS We evaluated the utility of noninvasive ECG signal analytics in post-ablation AF patients for the following features: 1) Localization of ATs (i.e., right versus left atrium), and 2) Identification of common left AT mechanisms (i.e., focal vs. macroreentrant). Atrial waveforms from the surface ECG were used to analyze: 1) Spectral organization, including dominant amplitude (DA) and mean spectral profile (MP), and 2) Temporospatial variability, using temporospatial correlation coefficients. We studied 94 ATs in 71 patients who had undergone prior pulmonary vein isolation for AF and returned for a second ablation: 1) right atrial cavotricuspid-isthmus dependent (CTI) ATs (n=21); 2) left atrial macroreentrant ATs (n=41) and focal ATs (n=32). Right CTI ATs manifested higher DAs and lower MPs than left ATs, indicative of greater stability and less complexity in the frequency spectrum. Left macroreentrant ATs possessed higher temporospatial organization than left focal ATs. CONCLUSIONS Noninvasively recorded atrial waveform signal analyses show that right ATs possess more stable activation properties than left ATs, and left macroreentrant ATs manifest higher temporospatial organization than left focal ATs. Further prospective analyses evaluating the role these novel ECG-derived tools can play to help localize and identify mechanisms of common ATs in AF ablation patients are warranted.

Novel noncontact charge density map in the setting of post-atrial fibrillation atrial tachycardias: first experience with the Acutus SuperMap Algorithm

“…Atrial tachycardias (AT) can be observed following ablation of atrial fibrillation (AF) in 5-25% of cases [1][2][3][4]. The underlying mechanisms comprise focal AT, micro re-entry, and more often macro re-entrant circuits [5]. Although three-dimensional (3D) mapping is of great use in mapping AT, ablation of these remains arduous [6].…”

Patient-Specific Identification of Atrial Flutter Vulnerability–A Computational Approach to Reveal Latent Reentry Pathways

“…The long-term success rate of atrial fibrillation (AF) ablation is unsatisfactory low, particularly in patients suffering from persistent AF. Besides AF recurrence, the development of post-ablational atrial flutter (AFlut) represents a major problem (Villacastín et al, 2003; Kobza et al, 2004; Chugh et al, 2005; Patel et al, 2008; Yamada and Kay, 2013; Biviano et al, 2015). In more than half of the patients, sustained AF is reinitiated within 5 years after ablation or AFlut develops (Bunch et al, 2016).…”