Electroanatomical mapping for visualization of atrial activation in patients with incisional atrial tachycardias

Aims Incisional atrial tachycardias in patients following surgery for congenital heart disease are based on complex structural abnormalities in these hearts. The aim of this study was to evaluate the use of the electroanatomical mapping system, CARTO, in consecutive patients with different forms of...

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Bibliographic Details
Published in:European heart journal 2001-02, Vol.22 (3), p.237-246
Main Authors: Reithmann, C., Hoffmann, E., Dorwarth, U., Remp, T., Steinbeck, G.
Format: Article
Language:English
Subjects:
Adult
Atrial tachycardia
Biological and medical sciences
Cardiac dysrhythmias
Cardiology. Vascular system
Catheter Ablation
Child
congenital heart disease
electroanatomical mapping
Electrophysiologic Techniques, Cardiac
Female
Heart
Heart Atria - physiopathology
Heart Conduction System - physiopathology
Humans
Male
Medical sciences
Middle Aged
Models, Anatomic
Models, Cardiovascular
Tachycardia - physiopathology
Tachycardia - surgery
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Summary:Aims Incisional atrial tachycardias in patients following surgery for congenital heart disease are based on complex structural abnormalities in these hearts. The aim of this study was to evaluate the use of the electroanatomical mapping system, CARTO, in consecutive patients with different forms of incisional atrial tachycardia. Methods and Results The electroanatomical mapping system combines electrophysiological and spatial information and allows visualization of atrial activation in a three-dimensional anatomical reconstruction of the atria. Electroanatomical mapping of right atrial activation was performed in 10 patients after surgery for congenital heart disease, surgery for Wolff–Parkinson–White syndrome, or heart transplantation presenting with 13 incisional atrial tachycardias. The three-dimensional mapping allowed a rapid distinction between focal (n=3) and reentrant mechanisms (n=10) and visualization of the activation wavefronts along anatomical and surgically created barriers. Electroanatomical activation maps (mean right atrial activation time 213±107ms) were constructed with 89±60 catheter positions during an average mapping time of 48±33 min. Reentrant tachycardias propagating through the tricuspid annulus–vena cava inferior isthmus (n=6) or along periatriotomy loops (n=4) were identified in eight patients. Ectopic atrial foci near surgical scars could be localized in three patients. Catheter ablation by creation of a lesion in a critical isthmus of conduction or by targeting the arrhythmogenic focus eliminated 11 of 13 incisional atrial tachycardias. Conclusion Visualization of atrial activation in a three-dimensional reconstruction of the right atrium using the electroanatomical mapping system CARTO facilitates understanding of the mechanism and defines the reentrant circuits of incisional atrial tachycardias. This new method may improve the success rate of electrophysiologically guided and anatomically guided catheter ablation of incisional atrial tachycardias.
ISSN:0195-668X
1522-9645
DOI:10.1053/euhj.2001.2468