Electroanatomic mapping of postpacing intervals clarifies the complete active circuit and variants in atrial flutter

Santucci, Peter; Varma, Niraj; Cytron, Joseph; Akar, Joseph G.; Wilber, David J.; Chekakie, M. Obadah Al; Brysiewicz, Neil

doi:10.1016/j.hrthm.2009.08.010

Cited by 41 publications

(21 citation statements)

References 23 publications

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“…Another example is reentry around the tricuspid annulus, with 5 of 7 simulations of sustained activity with structural remodeling resulting in the direction of rotation being counter-clockwise. Such right-atrial reentry, involving slow conduction through the isthmus, is typical in patients with AFl [26], [56] often with the majority (19/26) of cases having counter-clockwise rotation around the tricuspid annulus [57].…”

Section: Discussionmentioning

confidence: 99%

Effects of Electrical and Structural Remodeling on Atrial Fibrillation Maintenance: A Simulation Study

2012

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Atrial fibrillation, a common cardiac arrhythmia, often progresses unfavourably: in patients with long-term atrial fibrillation, fibrillatory episodes are typically of increased duration and frequency of occurrence relative to healthy controls. This is due to electrical, structural, and contractile remodeling processes. We investigated mechanisms of how electrical and structural remodeling contribute to perpetuation of simulated atrial fibrillation, using a mathematical model of the human atrial action potential incorporated into an anatomically realistic three-dimensional structural model of the human atria. Electrical and structural remodeling both shortened the atrial wavelength - electrical remodeling primarily through a decrease in action potential duration, while structural remodeling primarily slowed conduction. The decrease in wavelength correlates with an increase in the average duration of atrial fibrillation/flutter episodes. The dependence of reentry duration on wavelength was the same for electrical vs. structural remodeling. However, the dynamics during atrial reentry varied between electrical, structural, and combined electrical and structural remodeling in several ways, including: (i) with structural remodeling there were more occurrences of fragmented wavefronts and hence more filaments than during electrical remodeling; (ii) dominant waves anchored around different anatomical obstacles in electrical vs. structural remodeling; (iii) dominant waves were often not anchored in combined electrical and structural remodeling. We conclude that, in simulated atrial fibrillation, the wavelength dependence of reentry duration is similar for electrical and structural remodeling, despite major differences in overall dynamics, including maximal number of filaments, wave fragmentation, restitution properties, and whether dominant waves are anchored to anatomical obstacles or spiralling freely.

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Section: Discussionmentioning

confidence: 99%

Effects of Electrical and Structural Remodeling on Atrial Fibrillation Maintenance: A Simulation Study

2012

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“…In fact, variations of typical flutter have been described in which required components of the circuit exist in the posterior RA. [12][13][14] Regardless of the ablation approach, verifying line of block across the ablation lesions is a critical end point for the procedure. This is supported by our finding that patients who achieved noninducibility but without strict verification of line of block developed recurrent arrhythmias that required reablation (in 3 of 4 patients without verification of block in the lateral wall or CTI).…”

Section: Ablation Approaches To Lateral Wall Re-entry and Verifying Lmentioning

confidence: 99%

A Novel Criterion for Conduction Block After Catheter Ablation of Right Atrial Tachycardia After Mitral Valve Surgery

Kanagasundram

Baduashvili

Liu

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background— One operative approach to the mitral valve, the superior transseptal incision, is proarrhythmic because of extensive atriotomies. The objective of this study is to describe complex atrial tachycardias (ATs) that occur after this approach and propose methods to verify lines of block as an end point for catheter ablation. Methods and Results— Of the 69 patients who had electrophysiological studies for AT after mitral valve surgery, 20 patients had prior superior transseptal incisions. Of these, 14 had complex ATs involving the lateral right atrium (RA). There were 9 dual-loop, 4 single-loop, and 1 focal tachycardias. Lateral wall ablation was performed either by creating a linear lesion from the lateral atriotomy to the inferior vena cava, superior vena cava, or tricuspid annulus or by ablating focally in the lateral RA. After a single ablation procedure, conduction block in the lateral wall was verified in 10 of 14 patients using 1 of 2 distinct patterns of block. One pattern consisted of late activation in an anterolateral corridor of the RA, and a second pattern consisted of wide-spaced double potentials. Recurrent conduction through the lateral wall lesions was associated with intraprocedural and late recurrences of ATs. Conclusions— The optimal end point for ablating ATs after mitral valve surgery with the superior transseptal approach is to establish lines of block that can be recognized by characteristic patterns of activation in the lateral RA. A novel criterion for lateral conduction block after catheter ablation is identification of a late-activated corridor in the anterolateral RA.

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“…Analogous to local activation and voltage, these parameters may be manually annotated or automatically annotated using proprietary software, and then displayed on the three-dimensional geometry. An example is the creation of entrainment maps using an EAM system [26,27]. Several investigators have confirmed the feasibility of such an approach by colour-coding entrainment data (either post-pacing intervals (PPI) or alternatively PPI-TCL) to identify the circuit of macroreentrant arrhythmias [28].…”

Section: Novel Applications Of Electroanatomical Mappingmentioning

confidence: 99%

Modern Electrophysiology Mapping Techniques

Thiagalingam

Stiles

2012

Heart, Lung and Circulation

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Electroanatomic mapping of postpacing intervals clarifies the complete active circuit and variants in atrial flutter

Cited by 41 publications

References 23 publications

Effects of Electrical and Structural Remodeling on Atrial Fibrillation Maintenance: A Simulation Study

Effects of Electrical and Structural Remodeling on Atrial Fibrillation Maintenance: A Simulation Study

A Novel Criterion for Conduction Block After Catheter Ablation of Right Atrial Tachycardia After Mitral Valve Surgery

Modern Electrophysiology Mapping Techniques

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