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Identification of critical isthmus using coherent mapping in patients with scar-related atrial tachycardia.

Abstract：

INTRODUCTION:Accurate identification of slow conducting regions in patients with scar-related atrial tachycardia (AT) is difficult using conventional electrogram annotation for cardiac electroanatomic mapping (EAM). Estimating delays between neighboring mapping sites is a potential option for activation map computation. We describe our initial experience with CARTO 3 Coherent Mapping (Biosense Webster Inc,) in the ablation of complex ATs. METHODS:Twenty patients (58 ± 10 y/o, 15 males) with complex ATs were included. We created three-dimensional EAMs using CARTO 3 system with CONFIDENSE and a high-resolution mapping catheter (Biosense Webster Inc). Local activation time and coherent maps were used to aid in the identification of conduction isthmus (CI) and focal origin sites. System-defined slow or nonconducting zones and CI, defined by concealed entrainment (postpacing interval < 20 ms), CV < 0.3 m/s and local fractionated electrograms were evaluated. RESULTS:Twenty-six complex ATs were mapped (mean: 1.3 ± 0.7 maps/pt; 4 focal, 22 isthmus-dependent). Coherent mapping was better in identifying CI/breakout sites where ablation terminated the tachycardia (96.2% vs 69.2%; P = .010) and identified significantly more CI (mean/chamber 2.0 ± 1.1 vs 1.0 ± 0.7; P < .001) with narrower width (19.8 ± 10.5 vs 43.0 ± 23.9 mm; P < .001) than conventional mapping. Ablation at origin and CI sites was successful in 25 (96.2%) with long-term recurrence in 25%. CONCLUSIONS:Coherent mapping with conduction velocity vectors derived from adjacent mapping sites significantly improved the identification of CI sites in scar-related ATs with isthmus-dependent re-entry better than conventional mapping. It may be used in conjunction with conventional mapping strategies to facilitate recognition of slow conduction areas and critical sites that are important targets of ablation.

journal_name

J Cardiovasc Electrophysiol

journal_title

Journal of cardiovascular electrophysiology

authors

Vicera JJB,Lin YJ,Lee PT,Chang SL,Lo LW,Hu YF,Chung FP,Lin CY,Chang TY,Tuan TC,Chao TF,Liao JN,Wu CI,Liu CM,Lin CH,Chuang CM,Chen CC,Chin CG,Liu SH,Cheng WH,Tai LP,Huang SH,Chou CY,Lugtu I,Liu CH,Chen SA

doi

10.1111/jce.14457

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

1436-1447

issue

eissn

1045-3873

issn

1540-8167

journal_volume

pub_type

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Identification of critical isthmus using coherent mapping in patients with scar-related atrial tachycardia.