Revisiting anatomic macroreentrant tachycardia after atrial fibrillation ablation using ultrahigh-resolution mapping: Implications for ablation

Takigawa, Masateru; Derval, Nicolas; Frontera, Antonio; Martin, Ruairidh; Yamashita, Seigo; Cheniti, Ghassen; Vlachos, Konstantinos; Thompson, Nathaniel; Kitamura, Τakeshi; Wolf, Michael; Massoullié, Grégoire; Martin, Claire; Al-Jefairi, Nora; Amraoui, Sana; Duchâteau, Josselin; Klotz, Nicolas; Pambrun, Thomas; Denis, Arnaud; Sacher, Frédéric; Cochet, Hubert; Hocini, Mélèze; Haı̈ssaguerre, Michel; Jaı̈s, Pierre

doi:10.1016/j.hrthm.2017.10.029

Cited by 89 publications

(65 citation statements)

References 18 publications

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“…For focal arrhythmias, this typically requires only focal activation mapping surrounding the site of earliest activation, while for reentrant arrhythmias the strategy must be individualized to the culprit anatomic/functional substrate. Complex atrial arrhythmias may require a comprehensive map in order to fully understand the reentrant circuit and to design an effective strategy to interrupt it with ablation, or identify a common vulnerable isthmus . Interpretation of the map requires careful identification of activation sequence, and when complex electrograms are observed, careful annotation of fragmented signals (usually indicative of slow conduction) and of double potentials (usually indicative of activation of closely apposed tissues on either side of a line of block) are required .…”

Section: Chapter 2: Principles Of 3d Mappingmentioning

confidence: 99%

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

Kim

Chen

Ernst

et al. 2020

Journal of Arrhythmia

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Section: Chapter 2: Principles Of 3d Mappingmentioning

confidence: 99%

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

Kim

Chen

Ernst

et al. 2020

Journal of Arrhythmia

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“…One of the more common mechanisms of LA tachycardia after AF ablation is reentry around the mitral annulus (Figure ). This may involve the entire annulus or just part of the annulus as the wavefront detours around adjacent areas of a scar and propagates through gaps in prior ablation lines . A second form of AT involves the LA roof and propagates around a set of pulmonary veins, often referred to a “roof‐dependent reentry” (Figure ; Supplemental video 1).…”

Section: Underlying Substrate For Left Atrial Tachycardiasmentioning

confidence: 99%

“…Increasingly, ultrahigh‐density mapping is capable of revealing channels, which might be better targets for ablation than the conventional sites described above (Figure A). These sites, which form “practical isthmuses” for ablation, maybe narrow channels that are more easily interrupted and may not require long linear lesions . Such narrow channels arise in the presence of scar or incomplete lesions from prior treatment and are best detected with high‐resolution mapping capable of detecting conduction block and zones of slow conduction with low amplitude electrograms.…”

Section: Step 3: Identifying the Critical Sites For Ablationmentioning

confidence: 99%

“…These sites, which form "practical isthmuses" for ablation, maybe narrow channels that are more easily interrupted and may not require long linear lesions. 13 Such narrow channels arise in the presence of scar or incomplete lesions from prior treatment and are best detected with highresolution mapping capable of detecting conduction block and zones of slow conduction with low amplitude electrograms. New versions of mapping software can display global activation histograms, which allow the operator to rapidly identify an isthmus of slow conduction.…”

Section: Perimitral Reentry Is Interrupted By Creating a Linear Lesiomentioning

confidence: 99%

“…This may involve the entire annulus or just part of the annulus as the wavefront detours around adjacent areas of a scar and propagates through gaps in prior ablation lines. 13 A second form of AT involves the LA roof and propagates around a set of pulmonary veins, often referred to a "roof-dependent reentry" (Figure 3; Supplemental video 1). Another variant of LA tachycardia is confined to the anterior LA.…”

Section: Underlying Substrate For Left Atrial Tachycardiasmentioning

confidence: 99%

See 2 more Smart Citations

Approach to catheter ablation of left atrial flutters

Markowitz

Thomas

Liu

et al. 2019

Cardiovasc electrophysiol

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Left atrial tachycardias (ATs) most commonly occur after catheter or surgical ablation of atrial fibrillation and in patients with atrial myopathies. Pre‐existing scar in the left atrium (LA) can result in complex circuits, sometimes with narrow channels that can be detected with high‐resolution mapping. The most common forms of macroreentrant AT from the LA are variants of peri‐mitral and roof‐dependent reentry. Localized reentrant rhythms occur in the setting of fibrosis that gives rise to slow conduction and may occur adjacent to areas of prior ablation. The approach to treating these ATs involves first identifying the left atrial origin, defining the tachycardia circuit – which can be facilitated by ultrahigh density mapping and entrainment – and selecting a suitable isthmus to target for ablation. An important endpoint in ablating left atrial flutters is to establish and confirm bidirectional line of the block. Challenges in ablating these ATs include the presence of multiple tachycardias, defining circuits with complex activation patterns and achieving durable lines of block, particularly in the lateral mitral isthmus. Progress in treating these arrhythmias has come from new mapping technologies and the recognition of epicardial connections that allow for persistent conduction across ablation lesions. Also, advances in delivering energy to obtain complete transmural lesions promise to improve the long‐term success of ablating ATs from the LA.

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Characterization of temporal electrical activity patterns for detection of critical isthmus regions of recurrent atypical atrial flutter

Vonderlin

Siebermair

Mahabadi

et al. 2023

Clinical Cardiology

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Introduction Identifying the critical isthmus region (CIR) of atrial re‐entry tachycardias (AT) is challenging. The Lumipoint® (LP) software, developed for the Rhythmia® mapping system, aims to facilitate the successful ablation of ATs by identifying the CIR. Objective The objective of this study was to evaluate the quality of LP regarding the percentage of arrhythmia‐relevant CIR in patients with atypical atrial flutter (AAF). Methods In this retrospective study, we analyzed 57 AAF forms. Electrical activity (EA) was mapped over tachycardia cycle length resulting in a two‐dimensional EA pattern. The hypothesis was that EA minima suggest potential CIRs with slow‐conduction‐zone. Results A total of n = 33 patients were included, with the majority of patients being already preablated (69.7%). LP algorithm identified a mean of 2.4 EA minima and 4.4 suggested CIRs per AAF form. Overall, we observed a low probability of identifying only the relevant CIR (POR) at 12.3% but a high probability that at least one CIR is detected (PALO) at 98.2%. Detailed analysis revealed EA minima depth (≤20%) and width (>50 ms) as the best predictors of relevant CIRs. Wide minima occurred rarely (17.5%), while low minima were more frequently present (75.4%). Minima depth of EA ≤ 20% showed the best PALO/POR overall (95% and 60%, respectively). Analysis in recurrent AAF ablations (five patients) revealed that CIR in de novo AAF was already detected by LP during the index procedure. Conclusion The LP algorithm provides an excellent PALO (98.2%), but poor POR (12.3%) to detect the CIR in AAF. POR improved by preselection of the lowest and widest EA minima. In addition, there might be the role of initial bystander CIRs becoming relevant for future AAFs.

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Revisiting anatomic macroreentrant tachycardia after atrial fibrillation ablation using ultrahigh-resolution mapping: Implications for ablation

Cited by 89 publications

References 18 publications

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

Approach to catheter ablation of left atrial flutters

Characterization of temporal electrical activity patterns for detection of critical isthmus regions of recurrent atypical atrial flutter

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