Color-coded three-dimensional entrainment mapping for analysis and treatment of atrial macroreentrant tachycardia.
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.
Esato
Masahiro
M
University of Leipzig-Heart Center, Leipzig, Germany.
Hindricks
Gerhard
G
Sommer
Philipp
P
Arya
Arash
A
Gaspar
Thomas
T
Bode
Kerstin
K
Bollmann
Andreas
A
Wetzel
Ulrike
U
Hilbert
Sebastian
S
Kircher
Simon
S
Eitel
Charlotte
C
Piorkowski
Christopher
C
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