Europace Advance Access originally published online on May 3, 2007
Europace 2007 9(7):449-457; doi:10.1093/europace/eum055
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ELECTROPHYSIOLOGY
Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: identification and ablation of the mid-diastolic isthmus
1 Dipartimento di Scienze Cardiovascolari, Ospedale di Circolo e Fondazione Macchi, Università dell'Insubria, Viale Borri, 57. IT-21100 Varese, Italy; 2 Unità di Elettrofisiologia Diagnostica ed Interventistica, Ospedale Civile, Camposampiero, Italy; 3 Dipartimento di Cardiologia, Ospedale Civile di Mirano, Italy; 4 Laboratorio di Elettrofisiologia U.O. di Cardiologia, Ospedale S.Chiara, Trento, Italy; 5 C.C. dott.Pederzoli, Presidio Ospedaliero ULSS22, Peschiera del Garda, Italy; 6 Unità Operativa di Cardiologia Interventistica, Azienda Ospedaliera S. Maria Nuova, Reggio Emilia, Italy; 7 Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Bambino Gesù, Roma, Italy; 8 Unità Operativa di Cardiologia, Ospedale di Conegliano Veneto, Italy; 9 Dipartimento Cardiovascolare, Ospedale S.Bortolo, Vicenza, Italy; 10 Dipartimento Cardiovascolare, Ospedale Regionale S. Maria dei Battuti, Treviso, Italy
Aims This multicentre prospective study evaluated the ability of electroanatomic mapping (EAM) using a specific parameter setting to identify clearly the mid-diastolically activated isthmus (MDAI) and guide ablation of macro-re-entrant atrial tachycardia (MAT).
Methods and results Consecutive patients with MAT, different from typical isthmus-dependent atrial flutter, were enrolled. EAM was performed using a specific setting of the window of interest, calculated to identify the MDAI and guide ablation of this area. Sixty-five patients exhibiting 81 MATs (mean cycle length 308 ± 68 ms) were considered. Thirty-two (49.2%) had previous heart surgery. In 79 of 81 morphologies (97.5%), EAM reconstructed 95.9 ± 4.3% of the tachycardia circuit and identified the MDAI; 23 of the 79 morphologies (29.1%) were double-loop re-entry. Mapping of two morphologies was incomplete due to MAT termination after catheter bumping. In 73 of 79 mapped morphologies (92.4%), abolition of the MAT was obtained by 13.2 ± 12.4 applications. During the 14 ± 4 month follow-up, MAT recurred in 4 of the successfully treated patients (6.8%).
Conclusion EAM using a specific parameter setting proved highly effective at identifying the MDAI in MAT, even in patients with previous surgery and multiple re-entrant loops. Ablation of the MDAI yielded acute arrhythmia suppression with low rate of recurrence during follow-up.
Key Words: Macro-re-entrant atrial tachycardia, Electroanatomic mapping, Macro-re-entry, Catheter ablation of supraventricular arrhythmias
* Corresponding author. Tel: +39 0332 278934; fax: +39 0332 393309. E-mail address: rdeponti{at}alice.it
Manuscript submitted 9 January 2007. Accepted after revision 5 March 2007.
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