CLINICAL RESEARCH
Characterization of Focal Atrial Tachycardia Using High-Density Mapping
Prashanthan Sanders, MBBS, PhD*, ,*,
Mélèze Hocini, MD*,,
Pierre Jaïs, MD*,,
Li-Fern Hsu, MBBS*,,
Yoshihide Takahashi, MD*,,
Martin Rotter, MD*,,
Christophe Scavée, MD*,,
Jean-Luc Pasquié, MD, PhD*,,
Fréderic Sacher, MD*,,
Thomas Rostock, MD*,,
Chrishan J. Nalliah, BSc*,,
Jacques Clémenty, MD*, and
Michel Haïssaguerre, MD*,
* Hôpital Cardiologique du Haut-Lévêque, Bordeaux, France
Université Victor Segalen Bordeaux-II, Bordeaux, France
Manuscript received March 4, 2005;
revised manuscript received July 24, 2005,
accepted August 1, 2005.
* Reprint requests and correspondence: Dr. Prashanthan Sanders, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, Bordeaux-Pessac, France (Email: prash.sanders{at}heartrhythm.org).
Presented in part at the Heart Rhythm Society's 25th Annual Scientific Sessions, San Francisco, California, in 2004, and published in abstract form (Heart Rhythm 2004;1:S19).
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.
|
Abbreviations and Acronyms
| | AF = atrial fibrillation | | AT = atrial tachycardia | | CI = confidence interval | | CL = cycle length | | CS = coronary sinus | | LA = left atrial/atrium | | PV = pulmonary vein | | RA = right atrial/atrium |
|
This article has been cited by other articles:
|
|
|
|
 
M. Wieczorek, A. R. Salili, S. Kaubisch, and R. Hoeltgen
Catheter ablation of non-sustained focal right atrial tachycardia guided by virtual non-contact electrograms
Europace,
June 1, 2011;
13(6):
876 - 882.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Kurotobi, K. Iwakura, K. Inoue, R. Kimura, A. Okamura, Y. Koyama, Y. Tosyoshima, N. Ito, and K. Fujii
Multiple Arrhythmogenic Foci Associated With the Development of Perpetuation of Atrial Fibrillation
Circ Arrhythm Electrophysiol,
February 1, 2010;
3(1):
39 - 45.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Kirchhof, J. Bax, C. Blomstrom-Lundquist, H. Calkins, A. J. Camm, R. Cappato, F. Cosio, H. Crijns, H.-C. Diener, A. Goette, et al.
Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation'
Europace,
July 1, 2009;
11(7):
860 - 885.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Knackstedt, P. Schauerte, and P. Kirchhof
Electro-anatomic mapping systems in arrhythmias
Europace,
November 1, 2008;
10(suppl_3):
iii28 - iii34.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Knecht, M. Hocini, M. Wright, N. Lellouche, M. D. O'Neill, S. Matsuo, I. Nault, V. S. Chauhan, K. J. Makati, M. Bevilacqua, et al.
Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation
Eur. Heart J.,
October 1, 2008;
29(19):
2359 - 2366.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Takahashi, M. D. O'Neill, M. Hocini, R. Dubois, S. Matsuo, S. Knecht, S. Mahapatra, K.-T. Lim, P. Jais, A. Jonsson, et al.
Characterization of Electrograms Associated With Termination of Chronic Atrial Fibrillation by Catheter Ablation
J. Am. Coll. Cardiol.,
March 11, 2008;
51(10):
1003 - 1010.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. D. O'Neill, P. Jais, M. Hocini, F. Sacher, G. J. Klein, J. Clementy, and M. Haissaguerre
Catheter Ablation for Atrial Fibrillation
Circulation,
September 25, 2007;
116(13):
1515 - 1523.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M. Markowitz, D. Nemirovksy, K. M. Stein, S. Mittal, S. Iwai, B. K. Shah, D. P. Dobesh, and B. B. Lerman
Adenosine-Insensitive Focal Atrial Tachycardia: Evidence for De Novo Micro-Re-Entry in the Human Atrium
J. Am. Coll. Cardiol.,
March 27, 2007;
49(12):
1324 - 1333.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Ruchat, L. Dang, N. Virag, J. Schlaepfer, L. K. von Segesser, and L. Kappenberger
A biophysical model of atrial fibrillation to define the appropriate ablation pattern in modified maze
Eur J Cardiothorac Surg,
January 1, 2007;
31(1):
65 - 69.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Takahashi, M. Hocini, M. D. O'Neill, P. Sanders, M. Rotter, T. Rostock, A. Jonsson, F. Sacher, J. Clementy, P. Jais, et al.
Sites of Focal Atrial Activity Characterized by Endocardial Mapping During Atrial Fibrillation
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
2005 - 2012.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Haissaguerre, M. Hocini, P. Sanders, Y. Takahashi, M. Rotter, F. Sacher, T. Rostock, L.-F. Hsu, A. Jonsson, M. D. O'Neill, et al.
Localized Sources Maintaining Atrial Fibrillation Organized by Prior Ablation
Circulation,
February 7, 2006;
113(5):
616 - 625.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
