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CLINICAL STUDIES

Computer-assisted animation of atrial tachyarrhythmias recorded with a 64-electrode basket catheter

^a Deutsches Herzzentrum München and Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

Manuscript received November 20, 1998; revised manuscript received June 3, 1999, accepted August 25, 1999.

Reprint requests and correspondence: Dr. Bernhard Zrenner, Deutsches Herzzentrum München, Lazarettstrasse 36, D-80636, München, Germany
Zrenner{at}dhm.mhn.de

OBJECTIVES

The aim of this study was to assess the value of a new mapping technique based on computer-assisted animation of multielectrode basket catheter (BC) recordings in patients with atrial arrhythmias.

BACKGROUND

The three-dimensional activation patterns of cardiac arrhythmias are not completely understood owing to limitations of conventional mapping techniques.

METHODS

The study included 32 patients with atrial tachycardia (AT) and 38 patients with atrial flutter (AFL). A software program was developed to analyze the activation patterns based on 56 bipolar electrograms recorded with a 64-electrode BC deployed in the right atrium (RA).

RESULTS

The total time needed for the animation of activation patterns of atrial arrhythmias was 5 ± 0.8 min. In 22 patients with right AT, the animated maps revealed that arrhythmia was unifocal in 15 patients, multifocal in 2 patients, polymorphic in 4 patients and reentrant in 1 patient. In 10 patients with left AT, breakthroughs on the right side of the septum (2 in 8 patients and 1 in 2 patients) and a left-to-right activation of the RA were demonstrated. In patients with typical AF, the reentrant excitation was a broad activation front with preferential propagation around the tricuspid annulus. In patients with atypical AFL, the reentry circuit involved one of the venae cavae and a line of block located in the posterior wall.

CONCLUSIONS

The computer-assisted animation of multiple electrograms recorded with a BC is a valuable mapping tool that delineates the three-dimensional activation patterns of various atrial arrhythmias. The technique is appropriate for complex, short-lived or unstable arrhythmias.

Abbreviations and Acronyms   AFL = atrial flutter   AT = atrial tachycardia   BC = basket catheter   CS = coronary sinus   ECG = electrocardiogram or electrocardiographic   RA = right atrium or atrial

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