Activation Mapping With Integration of Vector and Velocity Information Improves the Ability to Identify the Mechanism and Location of Complex Scar-Related Atrial Tachycardias. (August 2018)

• Record Type: Journal Article
• Authors: Anter, Elad; Duytschaever, Mattias; Shen, Changyu; Strisciuglio, Teresa; Leshem, Eran; Contreras-Valdes, Fernando M.; Waks, Jonathan W.; Zimetbaum, Peter J.; Kumar, Kapil; Spector, Peter S.; Lee, Adam; Gerstenfeld, Edward P.; Nakar, Elad; Bar-Tal, Meir; Buxton, Alfred E.
• Is Part Of: Circulation. Volume 11:Number 8(2018)
• Publication Date: 2018-08
• Subjects: arrhythmias, cardiac -- heart atria -- humans -- prospective studies -- retrospective studies; Arrhythmia -- Periodicals; Heart -- Electric properties -- Periodicals; 616.128
• DOI: 10.1161/CIRCEP.118.006536
• Languages: English
• ISSNs: 1941-3149

Abstract

Abstract : Background: Activation mapping of scar-related atrial tachycardias (ATs) can be difficult to interpret because of inaccurate time annotation of complex electrograms and passive diastolic activity. We examined whether integration of a vector map can help to describe patterns of propagation to better explain the mechanism and location of ATs. Methods: The investigational mapping algorithm calculates vectors and applies physiological constraints of electrical excitation in human atrial tissue to determine the arrhythmia source and circuit. Phase I consisted of retrospective evaluation in 35 patients with ATs. Phase II consisted of prospective validation in 20 patients with ATs. Macroreentry was defined as a continuous propagation in a circular path >30 mm; localized reentry was defined as a circular path ⩽30 mm; a focal source had a centrifugal spread from a point source. Results: In phase I, standard activation mapping identified 28 of 40 ATs (70%): 25 macroreentry and 3 focal tachycardias. In the remaining 12 ATs, the mechanism and location could not be identified by activation and required entrainment or empirical ablation for termination (radiofrequency time, 17.3±6.6 minutes). In comparison, the investigational algorithm identified 37 of 40 (92.5%) ATs, including 5 macroreentry, 3 localized reentry, and 1 focal AT not identified by standard mapping. It also predicted the successful termination site of all 37 of 40 ATs. In phase II, the investigational algorithm identified 12 macroreentry, 6 localized reentry, and 2 focal tachycardias that all terminated with limited ablation (3.2±1.7 minutes). It identified 3 macroreentry, 3 localized reentry, and 1 focal AT not well characterized by standard mapping. The diagnosis of localized reentry was supported by highly curved vectors, resetting with increasing curve and termination with limited ablation (22±6 s). Conclusions: Activation mapping integrating vectors can help determine the arrhythmia mechanism and identify its critical components. It has particular value for identifying complex macroreentrant circuits and for differentiating a focal source from a localized reentry. Abstract : Supplemental Digital Content is available in the text.