Is the mid-diastolic isthmus always the best ablation target for re-entrant atrial tachycardias?

We evaluated the ability of an ultrahigh mapping system to identify the most convenient Rhythmia ablation target (RAT) in intra-atrial re-entrant tachycardias (IART) in terms of the narrowest area to transect to interrupt the re-entry. A total of 24 consecutive patients were enrolled with a total of 26 IARTs. The Rhythmia mapping system was used to identify the RAT in all IARTs. In 18 cases the RAT matched the mid-diastolic phase of the re-entry whereas in 8 cases the RAT differed. In these patients, the mid-diastolic tissue in the active circuit never represented the area with the slowest conduction velocity of the re-entry. The mean conduction velocity at the mid-diastolic site was significantly slower in the group of patients in which the RAT matched the mid-diastolic site (P = 0.0173) and that of the remaining circuit was significantly slower in the group in which the RAT did not match (P = 0.0068). The mean conduction velocity at the RAT was comparable between the two groups (P = 0.66). Identifying the RAT in challenging IARTs by means of high-density representation of the wavefront propagation of the tachycardia seems feasible and effective. In one-third of cases this approach identifies an area that differs from the mid-diastolic corridor.

Citation

Antonio De Simone, Matteo Anselmino, Marco Scaglione, Giuseppe Stabile, Francesco Solimene, Antonio De Bellis, Marco Pepe, Alfonso Panella, Federico Ferraris, Maurizio Malacrida, Francesco Maddaluno, Fiorenzo Gaita, Ignacio García-Bolao. Is the mid-diastolic isthmus always the best ablation target for re-entrant atrial tachycardias? Journal of cardiovascular medicine (Hagerstown, Md.). 2020 Feb;21(2):113-122

Mesh Tags

PMID: 31895131

search → result