Catheter ablation of atypical atrial flutter: a novel 3D anatomic mapping approach to quickly localize and terminate atypical atrial flutter

Sundaram, Sri; Choe, William; Jordan, J. Ryan; Mullins, Nate; Boorman, Charles; Kessler, Eric; Nath, Sunil

doi:10.1007/s10840-017-0269-z

Cited by 17 publications

(18 citation statements)

References 24 publications

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“…Both studies performed ablations without HDM support. Two studies relying on HD activation sequence mapping demonstrate LA flutter termination rates of almost 100% which goes in line with the high success rates in our study 2,23 …”

Section: Discussionsupporting

confidence: 90%

“…Two studies relying on HD activation sequence mapping demonstrate LA flutter termination rates of almost 100% which goes in line with the high success rates in our study. 2,23 With respect to midterm outcome we show that arrhythmia recurrence rates are comparable between preablated and ablationnaïve individuals (recurrence rates: 14 of 39 (35.9%) and 4 of 16 (25%), respectively, after 2 years. This is consistent with the reported midterm outcomes in literature between 18% and 49%.…”

Section: Acute and Midterm Success Ratesmentioning

confidence: 75%

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Impact of previous left atrial ablation procedures on the mechanism of left atrial flutter: A single‐centre experience

Siebermair

Kochhäuser

Kupusovic

et al. 2020

Cardiovasc electrophysiol

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Introduction Left atrial flutter predominantly occurs after surgical or ablation procedures but this entity has also been recently reported in individuals without previous interventions. The use of high‐density electroanatomical mapping‐systems (HDM) has improved the understanding of underlying mechanisms beyond entrainment maneuvers and substrate analyses. We aimed to evaluate the mechanism of left atrial (LA) flutters in preablated vs ablation‐naïve individuals and sought to assess the efficacy of empiric ablations sets in these groups. Methods and results We included 55 patients admitted for ablation of LA flutter between July 2017 and August 2019. On the basis of HDM analyses the arrhythmia mechanism was determined with consecutive ablation targeting the suspected critical isthmus. Mean age was 69.8 ± 10.7 years, with 26 of 55 (47.3%) male patients. Thirty‐nine (71%) patients had previously undergone LA ablation. Arrhythmia mechanisms differed between preablated and ablation‐naïve patients as anatomical structure‐related LA flutters (perimitral, roof‐dependent, within‐pulmonary veins) were more frequent in the preablated cohort compared to ablation‐naïve individuals (74.4% vs 43.8%; P = .03). In ablation‐naïve patients, most flutters (9 of 16, 56.3%) were related to low‐voltage areas at the anterior/posterior wall. Acute termination rates were high (>90%) in both groups. Empirical mitral isthmus or roof lines showed a potential higher success rate in preablated patients. Conclusion We identified different mechanisms of LA flutters in preablated vs ablation‐naïve patients. In ablation‐naïve patients, most tachycardias involved low‐voltage areas rather than anatomical structures. Using HDM, acute success rates were high. Hypothetical linear ablations were less successful in ablation‐naïve individuals, further highlighting the need to identify the specific individual tachycardia mechanism in these patients.

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Section: Discussionsupporting

confidence: 90%

Section: Acute and Midterm Success Ratesmentioning

confidence: 75%

Impact of previous left atrial ablation procedures on the mechanism of left atrial flutter: A single‐centre experience

Siebermair

Kochhäuser

Kupusovic

et al. 2020

Cardiovasc electrophysiol

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“…In several recent series with high-density mapping, targeting the functional rather than the anatomical isthmus has been the main ablation strategy [11][12][13]. It should be considered that many of these studies [12,13] have been performed with the Rhythmia system, which actually creates high density maps, but probably does not facilitate the linear ablation with complete and transmural lesions, as this system did not have catheters with contact force technology.…”

Section: Conduction Velocities and Implications For Pmf Ablationmentioning

confidence: 99%

“…However, it is one of the possible options in cases where PVI alone is not considered sufficient, such as in redo cases with well-maintained PVI [7], long-lasting persistent AF [8,9], or diseased myocardium with low-voltage electrical activity [10]. On the other hand, MI ablation is an effective therapy for PMF, however, these reentrant tachycardias can also be treated by ablating critical isthmuses with slow conduction zones [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Incidence, electrophysiological characteristics, and long-term follow-up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block

Ioannidis

Christoforatou

Zografos

et al. 2020

Preprint

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Introduction: After mitral isthmus (ΜΙ) catheter ablation, perimitral atrial flutter (PMF) circuits can be maintained due to the preservation of residual myocardial connections, even if conventional pacing criteria for complete MI block are apparently met (MI pseudo-block). We aimed to study the incidence, the electrophysiological characteristics, and the long-term outcome of these patients. Methods and Results: Seventy-two consecutive patients (mean age 62.4±10.2, 62.5% male) underwent MI ablation, either as part of an atrial fibrillation (AF) ablation strategy (n=35), or to treat clinical reentrant atrial tachycardia (AT) (n=32), or to treat AT that occurred during ablation for AF (n=5). Ιn all patients the electrophysiological characteristics of PMF circuits were studied by high-density mapping. MI block was successfully achieved in 69/72 patients (95.6%). Five patients developed PMF after confirming MI block. In these patients, high-density mapping during the PMF showed a breakthrough in MI with extremely low impulse conduction velocity (CV). In contrast, in usual PMF circuits that occurred after AF ablation, the lower CV of the reentrant circuit was of significantly higher value (0.07±0.02m/s vs 0.25±0.07m/s, respectively; P<0.001).Patients presented with clinical AT had better prognosis in maintaining sinus rhythm after MI ablation compared with patients presented with AF. Conclusion: PMF with MI pseudo-block may be present after MI ablation and has specific electrophysiological features characterized by remarkably slow CV in the MI. Thus, even after MI block is achieved, a more detailed mapping in the boundaries of the ablation line or reinduction attempts may be needed to exclude residual conduction.

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“…The configuration of the mapping system has been previously described in detail. 1,2 Briefly, the EnSite™ Precision™ mapping system was set to display all of the mapping points with only eight isochronal color bands in the following activation pattern: white → red → orange → yellow → green → light blue → dark blue → purple. Each color band represents equally spaced timing.…”

mentioning

confidence: 99%

Use of Three-dimensional Mapping to Identify an Alternating Atrial Activation Pattern in the Coronary Sinus

Sundaram

Boorman

Mullins

et al. 2018

J Innov Cardiac Rhythm Manage

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Atypical left atrial flutters present following atrial fibrillation ablation have been well-documented in the literature. These arrhythmias are known to be difficult to localize and ablate. An atypical flutter with an alternating activation pattern in the coronary sinus, however, is unusual and has rarely been discussed. In this case report, we describe the use of high-density three-dimensional anatomic mapping to successfully localize and terminate an atypical flutter with an alternating atrial activation pattern in the coronary sinus.

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Catheter ablation of atypical atrial flutter: a novel 3D anatomic mapping approach to quickly localize and terminate atypical atrial flutter

Abstract: Ablation of atypical atrial flutter is challenging and time consuming. This case series shows that HD-VGM mapping can quickly localize and terminate an atypical flutter circuit.

Cited by 17 publications

References 24 publications

Impact of previous left atrial ablation procedures on the mechanism of left atrial flutter: A single‐centre experience

Impact of previous left atrial ablation procedures on the mechanism of left atrial flutter: A single‐centre experience

Incidence, electrophysiological characteristics, and long-term follow-up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block

Use of Three-dimensional Mapping to Identify an Alternating Atrial Activation Pattern in the Coronary Sinus

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