Author + information
- Received October 10, 2018
- Revision received February 1, 2019
- Accepted February 1, 2019
- Published online April 15, 2019.
- Benjamin Schaeffer, MD∗∗ (, )
- Ruken Ö. Akbulak, MD∗,
- Mario Jularic, MD,
- Julia Moser, MD,
- Christian Eickholt, MD,
- Jana M. Schwarzl, MD,
- Niklas Klatt, MD,
- Pawel Kuklik, PhD,
- Christian Meyer, MD and
- Stephan Willems, MD
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center, and the DZHK Hamburg, Hamburg, Germany
- ↵∗Address for correspondence:
Dr. Benjamin Schaeffer, Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany.
Objectives This study sought to characterize primary left atrial tachycardia (LAT) mechanisms, electrical properties and substrate using high-density mapping.
Background Nonfocal LAT can be found in patients without prior substrate modifying interventions.
Methods Of 223 catheter ablation procedures for LAT 15 patients (60% male, age 74 ± 6 years) had nonfocal AT and no history of LA ablation or cardiac surgery.
Results AT (mean cycle length 244 ± 32 ms) were identified as macro–re-entry (12 of 15) or localized re-entry (3 of 15). High-density electroanatomical mapping (EAM, performed in 13 patients) revealed a high proportion of low voltage areas (LVA, <0.45 mV, 41 ± 22%). Anterior LVA regions were predominantly related to the macro–re-entry and directly perpetuating the re-entrant circuit in 8 patients by formation of a conductive channel (width: 14 ± 7 mm, length: 11 ± 3 mm) between the inferior pole of the scar and the mitral valve (MV) annulus with electrophysiological features of diseased tissue. A tailored anterior ablation line successfully terminated AT in 9 patients (6 dominant circuit MV dependent, 3 dominant circuit scar dependent AT), while a lateral isthmus line was performed in 2 patients. Localized re-entries were successfully targeted by local ablation. Acute successful ablation could be achieved in 14 of 15 patients leading to a freedom from any arrhythmias in 9 of 15 patients (60%) after follow-up of 343 ± 203 days.
Conclusions Patients with nonfocal left atrial tachycardia without previous iatrogenic interventions show evidence for advanced atrial myopathy. High-density mapping revealed involvement of the anterior LA and allows for an individualized ablation approach beyond strategies usually applied in consecutive AT.
↵∗ Drs. Schaeffer and Akbulak contributed equally to this work and are joint first authors.
Dr. Willems has received funding from and is a member of the Speakers Bureau of Boston Scientific. Dr. Eickholt has received speaker fees from Bristol-Myers Squibb, Abbott, Boehringer Ingelheim/Eli Lilly, and Boston Scientific; and has received grants from Biotronik, St. Jude Medical, and Biosense. Dr. Kuklik is a consultant for Acutus Medical, Inc. Dr. Meyer has received speaker fees from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 10, 2018.
- Revision received February 1, 2019.
- Accepted February 1, 2019.
- 2019 American College of Cardiology Foundation
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