Author + information
- Received November 5, 2018
- Revision received April 23, 2019
- Accepted April 25, 2019
- Published online August 19, 2019.
- Philippe Maury, MDa,b,∗∗ (, )
- Masateru Takigawa, MDc,d,∗,
- Stefano Capellino, BEe,
- Anne Rollin, MDa,
- Jean Rodolphe Roux, BEe,
- Pierre Mondoly, MDa,
- Franck Mandel, MDa,
- Benjamin Monteil, MDa,
- Arnaud Denis, MDc,d,
- Frederic Sacher, MDc,d,
- Meleze Hocini, MDc,d,
- Michel Haïssaguerre, MDc,d,
- Nicolas Derval, MDc,d and
- Pierre Jaïs, MDc,d
- aDepartment of Cardiology, University Hospital Rangueil, Toulouse, France
- bUnité Inserm U 1048, Toulouse, France
- cDepartment of Cardiology, University Hospital Haut-Lévèque, Pessac, France
- dLIRYC Institute/INSERM 1045, Bordeaux University Hospital, Bordeaux, France
- eBoston Scientific, Voisin Le Bretonneux, France
- ↵∗Address for correspondence:
Dr. Philippe Maury, Department of Cardiology, University Hospital Rangueil, 1 Avenue du Professeur Jean Poulhès, 31059 Toulouse Cedex 09, France.
Objectives This study sought to identify atrial tachycardia (AT) demonstrating atrial activation duration (AAD) lasting longer than the length of the tachycardia cycle (TCL); to assess AT prevalence; and to evaluate the mechanisms and characteristics associated with these AT episodes by using the Rhythmia system (Boston Scientific, Marlborough, Massachusetts).
Background Ultra-high-density mapping allows very accurate characterization of mechanisms involved in AT. Some complex patterns may involve AAD which is longer than the tachycardia cycle length (TCL) which makes maps difficult to interpret. Prevalence and characteristics of such ATs are unknown.
Methods A cohort of 100 consecutive patients undergoing ablation of 125 right (n = 21) or left (n = 104) ATs using ultra-high-density mapping were retrospectively included. Offline calculation of right or left AAD was compared to TCL.
Results Mean TCL was 293 ± 65 ms, and mean AAD was 291 ± 74 ms (p = NS). AT mechanisms were macro-re-entry in 74 cases (59%), localized re-entry in 27 cases (22%), and focal AT in 21 cases (17%) (types were mixed in 3 cases). Fifteen ATs (12%) had AADs that were longer than the TCL (71 ± 45 ms longer, from 10 to 150 ms). TCL was equal to the AAD in 97 ATs (78%), whereas 13 ATs (10%) had AAD shorter than the TCL (focal AT in each case). There were no differences between right and left atria for prevalence of ATs with AADs that were longer than the TCLs. There were significant differences in AT mechanisms according to the AAD-to-TCL ratio (p < 0.0001), with localized re-entry showing more often that AAD was longer than the TCL compared to that in focal AT and macro-re-entry.
Conclusions ATs with AAD lasting longer than the TCL were present in approximately 10% of the ATs referred for ablation, mostly in ATs caused by localized re-entry. Ultra-high-density mapping allows detection of these complex patterns of activation.
- activation duration
- atrial tachycardia
- focal tachycardia
- tachycardia cycle length
↵∗ Drs. Maury and Takigawa contributed equally to this work and are joint first authors.
Drs. Capellino and Roux are employees of Boston Scientific. Dr. Sacher is a speaker and consultant for Biosense Webster, Boston Scientific, Medtronic, Abbott, Microport, and Bayer Healthcare. 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 November 5, 2018.
- Revision received April 23, 2019.
- Accepted April 25, 2019.
- 2019 American College of Cardiology Foundation
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