Scientific publications

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

Feb 1, 2020 | Magazine: Journal of Cardiovascular Medicine

Antonio De Simone  1 , Matteo Anselmino  2 , Marco Scaglione  3 , Giuseppe Stabile  4 , Francesco Solimene  5 , Antonio De Bellis  1 , Marco Pepe  1 , Alfonso Panella  1 , Federico Ferraris  2 , Maurizio Malacrida  6 , Francesco Maddaluno  6 , Fiorenzo Gaita  2 , Ignacio García-Bolao  7

Aims: 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.

Methods: 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.

Results: 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).

Conclusion: 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  J Cardiovasc Med (Hagerstown). 2020  Feb;21(2):113-122. doi: 10.2459/JCM.0000000000000923

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