Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias

Strisciuglio, Teresa; Vandersickel, Nele; Lorenzo, Giuseppe Di; Nieuwenhuyse, Enid Van; Haddad, Milad El; Pooter, Jan De; Kyriakopoulou, Maria; Almorad, Alexandre; Lycke, Michelle; Vandekerckhove, Yves; Tavernier, René; Duytschaever, Mattias; Knecht, Sébastien

doi:10.1016/j.hrthm.2019.09.014

Cited by 16 publications

(12 citation statements)

References 17 publications

(21 reference statements)

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“…11 We hypothesize that fractionated continuous (or quasi-continuous) activity should be visualized within the majority of rotor cores on bipolar signals, as true functional microreentries (Figure 1, panel A); in fact, fragmentation to consider 'conventional' anatomical microreentry has been defined as that comprising >75% of the tachycardia cycle length. 9,18 In peripheral regions, however, we believe that spatiotemporal distribution of signals (i.e. all the AF cycle length comprised within the different bipoles of the mapping catheter), which may exhibit some fractionation but not on a continuous manner, could be the most frequent pattern.…”

Section: Discussionmentioning

confidence: 99%

“…4 Patients with unstable circuits have been excluded from most reentrant AT ablation series, which have focused on mappable circuits. 1,2,[5][6][7][8][9] These patients are frequently considered untreatable with ablation, and this may lead to stopping rhythm control and accepting the atrial arrhythmia is permanent. During the last years, ablation strategies that try to terminate AF, the 'most unstable' atrial arrhythmia, via identification and ablation of AF drivers (rotational or focal), have emerged.…”

Section: Introductionmentioning

confidence: 99%

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Stabilization of unstable reentrant atrial tachycardias via fractionated continuous electrical activity ablation (CHAOS study).

Franco

Lozano

Matía

et al. 2021

Preprint

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Introduction. Unstable reentrant atrial tachycardias (ATs) (i.e. those with frequent circuit modification or conversion to atrial fibrillation) are challenging to ablate. We have tested a strategy to achieve arrhythmia stabilization into mappable stable ATs based on the detection and ablation of rotors. Methods and Results. From May 2017 to December 2019, 97 consecutive patients with reentrant ATs were ablated. Of these, 18 (18.6%) presented unstable circuits and were included. Mapping was performed using conventional high-density mapping catheters (IntellaMap ORION, PentaRay NAV or Advisor HD Grid). Rotors were subjectively identified as fractionated continuous (or quasi-continuous) electrograms on 1-2 adjacent bipoles of the mapping catheter, without dedicated software. 13 patients (72%) had detectable rotors (median 2 [1–3] rotors per patient); focal ablation achieved conversion into stable AT or sinus rhythm in 12 (92%). In the other 6 patients, sites with spatiotemporal dispersion (i.e. all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles were targeted. 17 sites with spatiotemporal dispersion were detected and focally ablated. Globally, and excluding 1 patient with spontaneous AT stabilization, ablation success to stabilize the AT was achieved in 16/17 patients (94.1%). One-year freedom from atrial arrhythmias was similar between patients with unstable and stable ATs (66.7% Vs 65.8%, p=0.946). Conclusion. Most unstable reentrant ATs show detectable rotors, identified as sites with single-bipole fractionated quasi-continuous signals, or spatiotemporal dispersion plus non-continuous fractionation. Ablation of these sites is highly effective to stabilize the AT or convert it into sinus rhythm.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stabilization of unstable reentrant atrial tachycardias via fractionated continuous electrical activity ablation (CHAOS study).

Franco

Lozano

Matía

et al. 2021

Preprint

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“…The first presented case is part of the database of AT excitation patterns collected between April and August 2017, for patients undergoing ablation of symptomatic ATs at the AZ Sint-Jan Bruges Hospital (Belgium) [14]. The second case is a single case from another database presented in [31,32]. Data collection in both studies were approved by the local ethics committee of the AZ Sint-Jan Bruges Hospital.…”

Section: A Test Of the Afv-dt Methods On Two Clinical Datasetsmentioning

confidence: 99%

Finding type and location of the source of cardiac arrhythmias from the averaged flow velocity field using the determinant-trace method

Nieuwenhuyse

Xia

et al. 2021

Phys. Rev. E

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Life threatening cardiac arrhythmias result from abnormal propagation of nonlinear electrical excitation waves in the heart. Finding the locations of the sources of these waves remains a challenging problem. This is mainly due to the low spatial resolution of electrode recordings of these waves. Also, these recordings are subjected to noise. In this paper, we develop a different approach: the AFV-DT method based on an averaged flow velocity (AFV) technique adopted from the analysis of optical flows and the determinant-trace (DT) method used for vector field analysis of dynamical systems. This method can find the location and determine all important types of sources found in excitable media such as focal activity, spiral waves, and waves rotating around obstacles. We test this method on in silico data of various wave excitation patterns obtained using the Luo-Rudy model for cardiac tissue. We show that the method works well for data with low spatial resolutions (up to 8 × 8) and is stable against noise. Finally, we apply it to two clinical cases and show that it can correctly identify the arrhythmia type and location. We discuss further steps on the development and improvement of this approach.

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“…atrial flutter), atrial fibrillation (AF), ventricular tachycardia (VT) and ventricular fibrillation (VF). A tachycardia can have two mechanisms, a regular reentry or a regular single focal source [2,3]. For AT and VT, the reentry is usually reported to be anatomical, although it might be difficult to differentiate a small localized reentry from a functional reentry [4].…”

Section: Introduction 1different Types Of Arrhythmias and Sourcesmentioning

confidence: 99%

DG-Mapping: a novel software package for the analysis of any type of reentry and focal activation of simulated, experimental or clinical data of cardiac arrhythmia

Nieuwenhuyse

Hendrickx

Abeele

et al. 2022

Med Biol Eng Comput

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In this work we present the release of a novel easy-to-use software package called DGM or Directed-Graph-Mapping. DGM can automatically analyze any type of arrhythmia to find reentry or focal sources if the measurements are synchronized in time. Currently, DGM requires the local activation times (LAT) and the spatial coordinates of the measured electrodes. However, there is no requirement for any spatial organization of the electrodes, allowing to analyze clinical, experimental or computational data. DGM creates directed networks of the activation, which are analyzed with fast algorithms to search for reentry (cycles in the network) and focal sources (nodes with outgoing arrows). DGM has been mainly optimized to analyze atrial tachycardia, but we also discuss other applications of DGM demonstrating its wide applicability. The goal is to release a free software package which can allow researchers to save time in the analysis of cardiac data. An academic license is attached to the software, allowing only non-commercial use of the software. All updates of the software, user and installation guide will be published on a dedicated website www.dgmapping.com.

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Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias

Cited by 16 publications

References 17 publications

Stabilization of unstable reentrant atrial tachycardias via fractionated continuous electrical activity ablation (CHAOS study).

Stabilization of unstable reentrant atrial tachycardias via fractionated continuous electrical activity ablation (CHAOS study).

Finding type and location of the source of cardiac arrhythmias from the averaged flow velocity field using the determinant-trace method

DG-Mapping: a novel software package for the analysis of any type of reentry and focal activation of simulated, experimental or clinical data of cardiac arrhythmia

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