title: Color-coded three-dimensional entrainment mapping for analysis and treatment of atrial macroreentrant tachycardia.
abstract: BACKGROUND
  Mapping and ablation of atrial macroreentrant tachycardia focus on activation mapping with identification of the area of slow conduction.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate a new concept for analysis and treatment of macroreentrant tachycardia based on color-coded three-dimensional (3D) entrainment mapping and subsequent placement of strategic lesion lines.
  
  
  METHODS
  Twenty-six patients presented with macroreentrant tachycardia (cycle length 329 +/- 70 ms). Using nonfluoroscopic systems (CARTO 12, NavX 14), sequential mapping of the target atrium was performed. On each mapping point, the 3D location was paired with color-coded entrainment information so that the reentrant circuit could be directly visualized.
  
  
  RESULTS
  Procedural duration, fluoroscopy time, and radiofrequency time measured 181 +/- 58, 37 +/- 19, and 31 +/- 17 minutes, respectively. Thirty-nine macroreentrant tachycardias were ablated: perimitral 9, around pulmonary vein ostium 6, through left atrial roof 5, around left atrial appendage 3, right atrial cavotricuspid isthmus dependent 6, around right atrial scar 2, around superior vena cava 1, within the septum 5, and within the coronary sinus 2. Tachycardia termination and noninducibility of any macroreentrant tachycardia was the procedural end-point. In case of left atrial macroreentrant tachycardia, pulmonary vein isolation was completed. Follow-up with serial 7-day Holter covered 302 +/- 82 days. Two (8%) patients experienced recurrences of a pretreated macroreentrant tachycardia.
  
  
  CONCLUSIONS
  In patients with macroreentrant tachycardia, color-coded 3D entrainment mapping is feasible to accurately determine and visualize the 3D location of the reentrant circuit and to plan a strategic ablation line concept. That approach, not targeting the area of slow conduction of the circuit, resulted in excellent procedural success (100%), with long-term freedom from any tachycardia recurrences in 88% of patients.
authors.affiliation: University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Esato
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaspar
authors.forename: Kerstin
authors.initials: K
authors.lastname: Bode
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.forename: Ulrike
authors.initials: U
authors.lastname: Wetzel
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hilbert
authors.forename: Simon
authors.initials: S
authors.lastname: Kircher
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
mesh_terms: D000328:Adult; D000368:Aged; D018780:Body Surface Potential Mapping; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D013610:Tachycardia / Q000503:physiopathology* / Q000601:surgery