Characterization, Mapping, and Ablation of Complex Atrial Tachycardia: Initial Experience With a Novel Method of Ultra High-Density 3D Mapping.
Conventional mapping of complex atrial tachycardias (ATs) can be challenging. Thus, we evaluated feasibility and utility of a novel, ultra high-density 3D mapping approach to characterize and map AT in these cases.



Overall, 21 patients (67.4 ± 7.6 years; male: 52.4%, 1.9 ± 1.4 previous ablation procedures) with documented AT referred to our center underwent catheter ablation including ultra high-density mapping using a novel 64-electrode mini-basket catheter and an adjunctive 3D mapping system. A total of 24 AT (20 left atrial, 4 right atrial AT) were analyzed in 19 cases. In 2 patients, map acquisition failed due to scarce local electrograms and unstable AT cycle length, respectively. Underlying mechanisms were focal (n = 3), as well as local (n = 8) and macro (n = 13) reentry tachycardias with a mean cycle length of 311.8 ± 67.7 milliseconds. The analysis of propagation waves, activation and voltage revealed complex activation patterns and allowed for the identification of critical sites of AT initiation or maintenance without the need for further mapping techniques. In all cases critical sites could be verified by successful consecutive ablation. Mean mapping time was 19.4 ± 7.6 minutes, mean number of mapping points was 19,217 ± 10,270. Radiofrequency application until first effect was 165.1 ± 374.2 seconds; total procedure time was 157.6 ± 51.4 minutes, fluoroscopy time 21.7 ± 13.8 minutes, and total radiofrequency duration 1,016 ± 951.9 seconds, respectively. No severe complications occurred.



Ultra high-density mapping of complex AT is safe and feasible. Further, it enables detailed insight into AT mechanisms. Critical AT sites can be identified precisely in order to guide successful catheter ablation.
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany. b.schaeffer@uke.de.
Benjamin
B
Schaeffer
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany.
Boris A
BA
Hoffmann
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany.
Christian
C
Meyer
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany.
Ruken Ö
RÖ
Akbulak
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany.
Julia
J
Moser
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany.
Mario
M
Jularic
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany.
Christian
C
Eickholt
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany.
Jana M
JM
Nührich
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany.
Pawel
P
Kuklik
Department of Cardiology - Electrophysiology, University Hospital Hamburg, University Heart Center, DZHK, Hamburg, Germany.
Stephan
S
Willems
D000200:Action Potentials; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
RhythmiaTM; atrial tachycardia; catheter ablation; electroanatomical mapping; high-density mapping