Author + information
- Received August 26, 2019
- Revision received December 2, 2019
- Accepted December 2, 2019
- Published online May 18, 2020.
- Enrique Rodríguez Font, MD∗,
- Concepción Alonso-Martín, MD, PhD∗∗ (, )
- José M. Guerra, MD, PhD,
- Bieito Campos García, MD,
- Francisco Méndez Zurita, MD,
- Oscar Alcalde Rodríguez, MD,
- Zoraida Moreno Weidmann, MD,
- Hildemari Espinosa Viamonte, MD,
- Amin El Amrani Rami, MD,
- Jenson Maldonado Chavez, MD,
- Carlos González Matos, MD,
- Pelayo Torner Montoya, MD, PhD and
- Xavier Viñolas Prat, MD, PhD
- Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBERCV, Institut de Recerca HSCSP-IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- ↵∗Address for correspondence:
Dr. Concepción Alonso-Martín, Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, St. Antoni M. Claret, 167, 08025 Barcelona, Spain.
Objectives The aim of this study was to describe a mapping approach for ablation of complex atrial re-entrant tachycardias (ARTs) in which high-density activation maps are transformed into low-density activation maps displaying only the active part of the tachycardia circuit.
Background High-density activation maps during complex ARTs are challenging to interpret because they include the activation patterns of active and passive circuits. Entrainment mapping provides the identification of the active tachycardia circuit. However, current electroanatomic mapping systems are not capable of color-coding the information obtained from entrainment maneuvers.
Methods Seventeen consecutive patients with atypical atrial flutter were included. A high-density activation map was acquired during index tachycardia. Subsequently, entrainment maneuvers were performed to generate a low-density activation map in which only the activation of the atria directly involved in the flutter circuit was displayed.
Results Of all patients included, 82% were men, and their mean age was 62 ± 7 years. Structural heart disease was present in 59%, and 53% had undergone prior left atrial ablation procedures. Low-density activation maps were successfully generated from an average of 14 ± 3 entrainment points. Twenty circuits (95%) were identified in the left atrium and 1 (5%) in the right atrium. Ablation guided by low-density mapping successfully terminated all ARTs in 267 ± 353 s of radiofrequency application.
Conclusions Low-density mapping based on entrainment maneuvers provides a precise delineation of the active circuit during complex ARTs and resulted in successful arrhythmia termination. This approach can be easily incorporated into clinical practice.
↵∗ Drs. Rodríguez Font and Alonso-Martín contributed equally to this work and are joint first authors.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 August 26, 2019.
- Revision received December 2, 2019.
- Accepted December 2, 2019.
- 2020 American College of Cardiology Foundation
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