Entrainment mapping for rapid distinction of left and right atrial tachycardias

Miyazaki, Hidekazu; Stevenson, William G.; Stephenson, Kent; Soejima, Kyoko; Epstein, Laurence M.

doi:10.1016/j.hrthm.2006.01.014

Cited by 59 publications

(32 citation statements)

References 12 publications

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“…[15][16][17][18][19] A stimulus that captures the tissue in the excitable gap of the reentrant circuit resets the tachycardia during entrainment pacing. The resulting orthodromic wave front returns to the pacing site after completing one revolution along the circuit.…”

Section: Discussion and Teaching Pointsmentioning

confidence: 99%

How to Approach Reentrant Atrial Tachycardia After Atrial Fibrillation Ablation

Miyazaki

Kobori²,

Kuwahara³

et al. 2012

Circ: Arrhythmia and Electrophysiology

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A 63-year-old male patient was admitted for catheter ablation of persistent atrial fibrillation (AF). On echocardiography, the left atrial (LA) size was 48 mm and the left ventricular function was normal. After electric cardioversion, ipsilateral pulmonary veins (PVs) were circumferentially ablated in sinus rhythm using double-Lasso (Lasso, Biosense Webster, Diamond Bar, CA) technique. 1-3 Both ipsilateral PVs were simultaneously isolated. Two years later, the patient was admitted for the ablation of recurrent, drug-resistant atrial tachycardia (AT) ( Figure 1A).The baseline tachycardia cycle length (TCL) was 350 ms. A 20-pole mapping catheter (Irvine Biomedical Inc, Irvine, CA) was inserted through the right jugular vein and positioned in the coronary sinus (CS). An 8-mm-tip ablation catheter (Japan Lifeline Inc, Tokyo, Japan) was advanced into the LA through a transseptal puncture. Mapping during AT revealed the resumption of conduction in the right PVs. On entrainment mapping, the ⌬ post pacing interval (PPI-TCL) was found to be 120, 70, 56, and 10 ms at the low lateral right atrium, anterior LA, bottom of LA, and left septum near the right PVs, respectively. On activation mapping using a 3D electroanatomic mapping system (Carto, Biosense Webster), earliest atrial activation was observed on the roof of right superior vein and the latest at the bottom of right inferior vein. Successful entrainment from the superior and inferior veins revealed that both sites were within the tachycardia circuit ( Figure 1B and 2A). Entrainment from the LA septum near the right PVs demonstrated that septal myocardium was also a part of the reentrant circuit. Furthermore, P-wave morphology during entrainment pacing from near the roof of the right superior vein was identical to that observed during tachycardia ( Figure 2B). Mapping near the site of the earliest atrial activity on the 3D map identified a 140-ms-long, fractionated and low-amplitude signal (0.044 mV, Figure 3A and 3B). After 4.5 seconds of radiofrequency (RF) delivery at that site, the tachycardia terminated ( Figure 3C). Induction attempts from the right PVs were negative. In sinus rhythm, a gap in the circumferential PV lesion was observed at the site that showed latest activation during tachycardia ( Figure 4A and 4B). It was successfully ablated, ensuing in simultaneous right inferior and superior PVs isolation ( Figure 4C).

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Section: Discussion and Teaching Pointsmentioning

confidence: 99%

How to Approach Reentrant Atrial Tachycardia After Atrial Fibrillation Ablation

Miyazaki

Kobori²,

Kuwahara³

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…8,[12][13][14][15] Coffey et al 8 reported a strategy of detailed activation mapping followed by focused entrainment mapping of AF ablation-related ATs. Rostock et al 13 reported that 72% of persistent AF ablation-related ATs are macroreentrant and proposed a mapping strategy starting with entrainment mapping from up to 6 LA sites to establish the correct AT diagnosis.…”

Section: Previous Studiesmentioning

confidence: 99%

Overdrive Pacing From Downstream Sites on Multielectrode Catheters to Rapidly Detect Fusion and to Diagnose Macroreentrant Atrial Arrhythmias

Barbhaiya

Kumar

et al. 2014

Circulation

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Background-Entrainment criteria for macroreentrant arrhythmias are based on detecting fusion between tachycardia and paced wavefronts, but this is often difficult for atrial tachycardias (AT) after ablation of atrial fibrillation. Methods and Results-With the use of a multipolar catheter, pacing was performed from electrodes within the coronary sinus showing activation later than adjacent electrodes (downstream overdrive pacing) during 66 ATs in 62 patients: 20 cavotricuspid isthmus-dependent ATs, 20 perimitral ATs, 13 focal ATs with sequential coronary sinus activation, and 13 other macroreentrant left atrial ATs. The paced cycle length was 10 to 30 milliseconds below the tachycardia cycle length (TCL), and activation at the neighboring upstream electrodes was assessed. Downstream overdrive pacing at 48 sites close to a macroreentrant circuit (PPI−TCL <40 milliseconds, where PPI is postpacing interval) produced constant fusion demonstrated by a long stimulus to upstream atrial electrogram interval (S-A u ) >75% TCL and was consistent with orthodromic activation of the upstream site despite its close proximity to the pacing site. In contrast, downstream overdrive pacing at 18 sites during focal AT or remote from the macroreentrant AT circuit (PPI−TCL >40 milliseconds) always demonstrated a comparatively short S-A u <25% of TCL (12±4% versus 89±4% of TCL; P<0.001), consistent with direct activation. Conclusions-Selection of a downstream activation site for overdrive pacing can facilitate rapid recognition of macroreentry and proximity to the reentry circuit using a single multielectrode catheter by recognizing a PPI-TCL <40 milliseconds and S-A u >75% of TCL. Recognition of intracardiac constant fusion with this method is a novel criterion for transient entrainment.

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“…The postpacing intervals were measured at each location to identify the circuits. 3 Entrainment pacing, however, often terminates tachycardia; therefore, we did not attempt entrainment pacing in most cases.…”

Section: Electroanatomical Mapping and Ablationmentioning

confidence: 99%

Pulmonary Artery Mapping for Differential Diagnosis of Left-Sided Atrial Tachycardia

Hirai

Nakano

Yamamoto

et al. 2013

Circ J

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Background: Distinguishing left- and right-sided atrial tachycardia (AT) is often challenging. The coronary sinus (CS) provides information only concerning the anterior left atrium (LA). Potentials recorded in the pulmonary artery (PA) have been substituted for those of the upper posterior LA because of their anatomical relationship. Methods and Results:Three patterns were designed, using potentials in the PA, right atrium (RA) and CS, to predict the side of AT. Two patterns were for left-sided AT and 1 pattern was for right-sided AT. Ten left-sided and 11 right-sided ATs were investigated regardless of mechanism. Electrode catheters were inserted in the RA, His bundle region, and CS, and an ablation catheter was inserted into the left and/or right PA. The sequences from these catheters were analyzed before detailed electroanatomical mapping. Patterns were obtained for 20 of 21 ATs. The mechanism was focal in 16 ATs and macroreentry in 5. The method predicted left-sided AT with a sensitivity of 78%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 84%, and an accuracy of 90%. Conclusions:The use of potentials in PA combined with conventional RA and CS electrograms is useful for distinguishing left-sided AT from right-sided AT, regardless of mechanism. (Circ J 2013; 77: 345 - 351)

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Entrainment mapping for rapid distinction of left and right atrial tachycardias

Cited by 59 publications

References 12 publications

How to Approach Reentrant Atrial Tachycardia After Atrial Fibrillation Ablation

How to Approach Reentrant Atrial Tachycardia After Atrial Fibrillation Ablation

Overdrive Pacing From Downstream Sites on Multielectrode Catheters to Rapidly Detect Fusion and to Diagnose Macroreentrant Atrial Arrhythmias

Pulmonary Artery Mapping for Differential Diagnosis of Left-Sided Atrial Tachycardia

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