Characterization of focal atrial tachycardia using high-density mapping

Prashanthan Sanders, Mélèze Hocini, Pierre Jaïs, Li-Fern Hsu, Yoshihide Takahashi, Martin Rotter, Christophe Scavée, Jean-Luc Pasquié, Fréderic Sacher, Thomas Rostock, Chrishan J. Nalliah, Jacques Clémenty, Michel Haïssaguerre

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94 Citations (Scopus)

Abstract

OBJECTIVES: The goal of this study was to characterize the origin of focal atrial tachycardias (AT).

BACKGROUND: Focal ATs originate from a small area and spread centrifugally; however, activation at the AT origin has not been characterized.

METHODS: Twenty patients with AT having failed prior ablation or occurring after atrial fibrillation ablation were studied. After excluding macro-re-entry, AT was mapped using a 20-pole catheter (five radiating spines; diameter 3.5 cm), performing vector mapping to identify the earliest activity followed by high-density mapping at the AT origin. Localized re-entry was considered if >85% of the tachycardia cycle length (CL) was observed within the mapping field and was confirmed by entrainment.

RESULTS: A total of 27 ATs were mapped to the pulmonary vein ostia (n = 5), and left (n = 16) and right atria (n = 6). A localized focus was evidenced at the site of origin in 19 ATs (70%), whereas in 8 (30%), localized re-entry was evidenced by 95.2 +/- 4.5% of the tachycardia CL recorded within the mapping field and entrainment showed a post-pacing interval <20 ms longer than tachycardia CL (6 of 6 tested). Localized re-entry had a shorter CL (p = 0.009), slowed conduction at its origin (fractionated potential 115 +/- 19 ms vs. 64 +/- 22 ms, representing 49 +/- 10% and 20 +/- 10% of tachycardia CL, respectively; p < 0.0001), and were more often contiguous with regions of electrical silence or conduction abnormalities (88% vs. 32%; p = 0.01). In addition, mapping documented varying degrees of intra-atrial conduction block, preferential conduction (n = 5), and rapid bursts of myocardial activity (n = 1). At 11 +/- 7 months, none have had recurrence of AT.

CONCLUSIONS: High-density multielectrode mapping can be used to perform vector mapping to localize complex AT. It provides novel insight into the mechanisms of focal AT, distinguishing focal AT from localized re-entry.

Original languageEnglish
Pages (from-to)2088-2099
Number of pages12
JournalJournal of the American College of Cardiology
Volume46
Issue number11
DOIs
Publication statusPublished - 6 Dec 2005
Externally publishedYes

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