Functional substrate mapping characteristics during sinus rhythm predicts critical isthmus of reentrant atrial tachycardia

Background Atrial tachycardia (AT) is a commonly encountered rhythm disorder in patients with underlying atrial scar. The role of atrial late activation mapping during sinus rhythm to predict the critical isthmus (CI) of AT has yet to be systematically evaluated. We aimed to investigate the relation...

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Bibliographic Details
Published in:Journal of cardiovascular electrophysiology 2023-07, Vol.34 (7), p.1539-1548
Main Authors: Yorgun, Hikmet, Çöteli, Cem, Kılıç, Gül Sinem, Sezenöz, Burak, Dural, Muhammet, Ateş, Ahmet Hakan, Aytemir, Kudret
Format: Article
Language:English
Subjects:
Ablation
Adult
Aged
Atrial Fibrillation - diagnosis
Atrial Fibrillation - surgery
atrial late activation mapping
atrial tachycardia
Cardiac arrhythmia
Catheter Ablation
Cicatrix
Conduction
Echocardiography, Three-Dimensional
Female
fragmented electrogram
functional substrate mapping
Heart Rate - physiology
Humans
Male
Mapping
Middle Aged
Morphology
reentry
Retrospective Studies
Sinuses
Tachyarrhythmia
Tachycardia
Tachycardia, Supraventricular - diagnosis
Tachycardia, Supraventricular - surgery
Tachycardia, Ventricular
Voltage
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Summary:Background Atrial tachycardia (AT) is a commonly encountered rhythm disorder in patients with underlying atrial scar. The role of atrial late activation mapping during sinus rhythm to predict the critical isthmus (CI) of AT has yet to be systematically evaluated. We aimed to investigate the relationship between the functional substrate mapping (FSM) characteristics and the CI of reentrant ATs in patients with underlying atrial low‐voltage areas. Methods Patients with history of left AT who underwent catheter ablation with 3D mapping using high‐density mapping were enrolled. Voltage map and isochronal late activation mapping were created during sinus/paced rhythm to detect deceleration zones (DZ). Electrograms with continuous‐fragmented morphology were also tagged. After induction of AT, activation mapping was performed to detect CI of the tachycardia. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of atrial fibrillation or AT (≥30 s) during the follow‐up. Results Among 35 patients [mean age: 62 ± 9, gender: 25 (71.5%) female] with left AT, a total of 42 reentrant ATs induced. Voltage mapping during sinus rhythm revealed low‐voltage area of 37.1 ± 23.8% of the left atrium. The mean value of bipolar voltage, EGM duration, and conduction velocity during sinus rhythm corresponding to CI of ATs were 0.18 ± 0.12 mV, 133 ± 47 ms, and 0.12 ± 0.09 m/s, respectively. Total number of DZs per chamber was 1.5 ± 0.6, which were located in the low‐voltage zone (
ISSN:1045-3873
1540-8167
DOI:10.1111/jce.15961