Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: identification and ablation of the mid-diastolic isthmus

Ponti, Roberto De; Verlato, Roberto; Bertaglia, Emanuele; Greco, Maurizio Del; Fusco, Antonio; Bottoni, Nicola; Drago, Fabrizio; Sciarra, Luigi; Ometto, R; Mantovan, Roberto; Salerno‐Uriarte, Jorge A.

doi:10.1093/europace/eum055

Cited by 73 publications

(58 citation statements)

References 12 publications

(22 reference statements)

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“…Current 3D activation mapping systems play an important role in localizing the source of focal tachycardias and critical isthmuses of reentrant circuits [59][60][61][62][63][64]. The conversion of raw electrical data to "clean" activation maps requires an expert operator to validate the local activation time (LAT) assigned by software algorithm.…”

Section: Ripple Mappingmentioning

confidence: 99%

Maximizing the Effectiveness of Ablation for Arrhythmias in the Congenital Heart Patients

Arujuna

Bono

2016

Curr Cardiol Rep

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Arrhythmias are common in adults with congenital heart disease and account for a large proportion of hospitalizations. The complex anatomical heterogeneity, often in the presence of a delicate hemodynamic system, presents a significant electrophysiological challenge. This review outlines current clinical practice and advances in maximizing the effectiveness of ablation for arrhythmias in congenital heart patients.

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Section: Ripple Mappingmentioning

confidence: 99%

Maximizing the Effectiveness of Ablation for Arrhythmias in the Congenital Heart Patients

Arujuna

Bono

2016

Curr Cardiol Rep

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“…For each AT, the beginning of the mapping window of interest (WOI) was set to be 50 to 70 ms earlier than the onset of P wave, allowing the local activation time of the assumed origin or mid-diastolic isthmus to be allocated within the beginning of the WOI. 5 In cases where the onset of the P wave could not be clearly distinguished, the WOI was set to make the reference signal located at the middle of the interval. The duration of the WOI was set to be 10 to 20 ms less than the TCL.…”

Section: Three-dimensional Activation Mappingmentioning

confidence: 99%

Mapping of Focal Atrial Tachycardia With an Uninterpretable Activation Map After Extensive Atrial Ablation

Yang

Chen

et al. 2014

Circ: Arrhythmia and Electrophysiology

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All procedures were performed under conscious sedation and local anesthetized state. A 6F quadripolar and a decapolar catheter were © 2014 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-Atrial tachycardias (ATs) after extensive ablation are increasingly common and challenging arrhythmias. The prolonged intra-atrial conduction time (IACT) during ATs in the milieu may complicate the mapping of focal ATs. In this present study, we aim to characterize the electrophysiological features of ATs in this unique setting and to delineate an effective mapping strategy further. Methods and Results-In total, 13 patients (average age, 59±7 years) in a cohort of 80 patients referred for AT ablation were selected for the study. The patients all demonstrated an undistinguishable map not ready to be interpreted the 3-dimensional mapping. A total of 13 ATs were mapped with mean tachycardia cycle length of 296±70 ms. Two activation patterns were identified, which were referred to as pseudo-macroreentry and chaotic activation. The former was a focal AT originating from the vicinity of an area of conduction block with the IACT less than the window of interest duration (4 cases; IACT/ window of interest ratio range, 0.93-0.98). The latter refers to a focal AT exhibiting a disorderly color mapping display with IACT exceeding the window of interest duration (9 cases; IACT/window of interest ratio range, 1.02-1.29). The IACT was determined after resetting the annotation. All ATs were successfully eliminated at the originating site. Conclusions-We delineated a series of focal ATs in the setting of a significantly prolonged IACT encountered in patients after previous extensive ablation. Two activation patterns were identified, which may help facilitate the mapping of focal ATs in this setting.

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“…We believe that all registered FEGMs coincided with the slow conduction zones but the critical slowing of the tachycardia wavefront was marked by multicomponent diastolic FEGM. Slow-conduction diastolic isthmuses have been reported to be critical for maintaining the reentry circuit and therefore represent a target site for ablation 2, 6. Ablation transecting the FEGMs zone may help to prevent other atypical ATs using these zones of slow conduction.…”

Section: Discussionmentioning

confidence: 99%

Atrial Tachycardia in a Patient With Fabry’s Disease

Kiedrowicz

Cooklin

Carr-White

et al. 2016

HeartRhythm Case Reports

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Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: identification and ablation of the mid-diastolic isthmus

Abstract: EAM using a specific parameter setting proved highly effective at identifying the MDAI in MAT, even in patients with previous surgery and multiple re-entrant loops. Ablation of the MDAI yielded acute arrhythmia suppression with low rate of recurrence during follow-up.

Cited by 73 publications

References 12 publications

Maximizing the Effectiveness of Ablation for Arrhythmias in the Congenital Heart Patients

Maximizing the Effectiveness of Ablation for Arrhythmias in the Congenital Heart Patients

Mapping of Focal Atrial Tachycardia With an Uninterpretable Activation Map After Extensive Atrial Ablation

Atrial Tachycardia in a Patient With Fabry’s Disease

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