TY - JOUR
T1 - Characterization of focal atrial tachycardia using high-density mapping
AU - Sanders, Prashanthan
AU - Hocini, Mélèze
AU - Jaïs, Pierre
AU - Hsu, Li-Fern
AU - Takahashi, Yoshihide
AU - Rotter, Martin
AU - Scavée, Christophe
AU - Pasquié, Jean-Luc
AU - Sacher, Fréderic
AU - Rostock, Thomas
AU - Nalliah, Chrishan J.
AU - Clémenty, Jacques
AU - Haïssaguerre, Michel
PY - 2005/12/6
Y1 - 2005/12/6
N2 - 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.
AB - 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.
U2 - 10.1016/j.jacc.2005.08.044
DO - 10.1016/j.jacc.2005.08.044
M3 - Article
C2 - 16325047
SN - 0735-1097
VL - 46
SP - 2088
EP - 2099
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 11
ER -