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.
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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 |
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