Insights from atrial surface activation throughout atrial tachycardia cycle length: A new mapping tool

Takigawa, Masateru; Martin, Claire; Derval, Nicolas; Denis, Arnaud; Vlachos, Konstantinos; Kitamura, Τakeshi; Frontera, Antonio; Martin, Ruairidh; Cheniti, Ghassen; Lam, Anna; Bourier, Félix; Thompson, Nathaniel; Wolf, Michael; Massoulié, Grégoire; Escande, William; André, Clémentine; Zeng, Li; Nakatani, Yosuke; Roux, Jean-Rodolphe; Duchâteau, Josselin; Pambrun, Thomas; Sacher, Frédéric; Cochet, Hubert; Hocini, Mélèze; Haı̈ssaguerre, Michel; Jaı̈s, Pierre

doi:10.1016/j.hrthm.2019.04.029

Cited by 32 publications

(59 citation statements)

References 18 publications

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“…The lumipoint algorithm displays an activation histogram over the entire tachycardia cycle length with a normalized score. Takigawa and collaborators showed that the algorithm can be used to identify reentrant versus focal atrial tachycardia …”

Section: Determining Target Sitesmentioning

confidence: 99%

Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias

Bakker

2019

Pacing Clinical Electrophis

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The extracellular electrogram is caused by transmembrane currents that flow into extracellular space during propagation of the electrical impulse. Electrograms are usually recorded in unipolar or bipolar mode that have different characteristics, but provide complementary information. Both recording modes have specific advantages, but also suffer from disadvantages. Techniques to circumvent some of the weaknesses are reviewed. The origin of remote and fractionated deflections and their relation with electrode characteristics are discussed. Epicardial and endocardial sites of origin and breakthrough sites as well as the effect of fatty tissue on extracellular electrograms are presented. Induction of tachycardia to assess the arrhythmogenic area is not always possible because of hemodynamic instability of the patient. Techniques to assess sites with high reentry vulnerability without induction of arrhythmias are outlined such as activation‐repolarization mapping and decremental stimulation. Pitfalls of substrate mapping and techniques to avoid them as omnipolar mapping and characterization of complex electrograms by entropy are presented. Technical aspects that influence electrogram morphology as electrode size, filtering, contact force, and catheter position are delineated. Data from the various publications suggest that a combination of unipolar and bipolar electrogram analysis techniques is helpful to optimize determination of target sites for ablation.

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Section: Determining Target Sitesmentioning

confidence: 99%

Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias

Bakker

2019

Pacing Clinical Electrophis

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“…The high‐resolution mapping catheter allowed us to detect residual slow conduction between the right atriotomy and the tricuspid valve, 4 and was extremely fast and accurate in order to define the scar. The Lumipoint ™ software, a new automated algorithm, was actually very effective since it could eliminate the subjectivity of the human eye analyzing thousands of EGMs in a matter of seconds 3 . In this case, the Lumipoint tool was as fast as effective to find the line due to previous cardiac surgery: The highlighted area in Figure 2 demonstrates the presence of double potential, representing the surgery line.…”

Section: Discussionmentioning

confidence: 99%

“…The activation map revealed localized conduction within the right atrium, along the previous right atriotomy scar (Video S1). At this point, we used the new Lumipoint ™ algorithm, 3 rapidly allowing identification of a specific EGM characteristic such as double potentials ( Figure 2) and visualizing it within thousands of EGMs available. This tool clearly shows previous atriotomy points (gray tags, Figure 2).…”

Section: Methodsmentioning

confidence: 99%

Effective and fast characterization of a complex atrial flutter in patient with previous atrial surgery and ablation procedure: The importance of new ultra–high‐density mapping tools

Mascia

Sartori

Porto

2020

Clinical Case Reports

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“…Such narrow channels arise in the presence of scar or incomplete lesions from prior treatment and are best detected with high‐resolution mapping capable of detecting conduction block and zones of slow conduction with low amplitude electrograms. New versions of mapping software can display global activation histograms, which allow the operator to rapidly identify an isthmus of slow conduction . The histogram patterns also distinguish focal from reentrant arrhythmias.…”

Section: Step 3: Identifying the Critical Sites For Ablationmentioning

confidence: 99%

“…New versions of mapping software can display global activation histograms, which allow the operator to rapidly identify an isthmus of slow conduction. 36 The histogram patterns also distinguish focal from reentrant arrhythmias. Treating a "practical isthmus" has the potential of being more effective by targeting a site which might be more vulnerable to ablation and also avoiding long lines that could develop gaps that would be proarrhythmic.…”

Section: Perimitral Reentry Is Interrupted By Creating a Linear Lesiomentioning

confidence: 99%

Approach to catheter ablation of left atrial flutters

Markowitz

Thomas

Liu

et al. 2019

Cardiovasc electrophysiol

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Left atrial tachycardias (ATs) most commonly occur after catheter or surgical ablation of atrial fibrillation and in patients with atrial myopathies. Pre‐existing scar in the left atrium (LA) can result in complex circuits, sometimes with narrow channels that can be detected with high‐resolution mapping. The most common forms of macroreentrant AT from the LA are variants of peri‐mitral and roof‐dependent reentry. Localized reentrant rhythms occur in the setting of fibrosis that gives rise to slow conduction and may occur adjacent to areas of prior ablation. The approach to treating these ATs involves first identifying the left atrial origin, defining the tachycardia circuit – which can be facilitated by ultrahigh density mapping and entrainment – and selecting a suitable isthmus to target for ablation. An important endpoint in ablating left atrial flutters is to establish and confirm bidirectional line of the block. Challenges in ablating these ATs include the presence of multiple tachycardias, defining circuits with complex activation patterns and achieving durable lines of block, particularly in the lateral mitral isthmus. Progress in treating these arrhythmias has come from new mapping technologies and the recognition of epicardial connections that allow for persistent conduction across ablation lesions. Also, advances in delivering energy to obtain complete transmural lesions promise to improve the long‐term success of ablating ATs from the LA.

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Insights from atrial surface activation throughout atrial tachycardia cycle length: A new mapping tool

Cited by 32 publications

References 18 publications

Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias

Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias

Effective and fast characterization of a complex atrial flutter in patient with previous atrial surgery and ablation procedure: The importance of new ultra–high‐density mapping tools

Approach to catheter ablation of left atrial flutters

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