Abstract
Abstract
Background
High-resolution mapping offers superior accuracy in delineating conduction features; however, certain characteristics are still linked to elevated recurrence rates of atrial tachycardia (AT), suggesting the influence of additional mechanisms. This study systematically assessed the substrate of functional conduction block (FCB) regions in relation to the mechanisms of multiple ATs.
Methods
In this study, the Carto system facilitated the mapping of ATs in 13 patients undergoing ablation, each presenting with more than two AT variants. FCB regions were marked and further analyzed.
Results
A total of 33 sustained ATs were mapped across the patient cohort. FCB regions showed convertibility in 7 of 13 patients (54%). Three kinds of presentations can be summarized by the FCB region: Firstly, the FCB region could act as the main obstacle sustaining the localized reentrant pathway, for which rounding obviously has a direct correlation with the mechanism of the AT (27%). Secondly, the FCB regions could act as obstacle lines to reorganize the propagation of the reentry in localized AT and macroreentrant AT (55%). Lastly, the FCB region could act as a bystander and may not be related to the mechanism of the ATs (18%). The potentials in FCB regions mostly performed low voltages or fragmented potentials (FPs) in the ATs which they did not perform the conduction block (90%).
Conclusion
In multiple ATs, FCB regions may not be uncommon. The participation of FCB regions in the mechanism of ATs showed three different kinds of performance. The dynamic nature of this substrate may provide insight into the reasons for the high recurrence of related ATs.
Funder
Natural Science Foundation of Heilongjiang Province of China
Publisher
Springer Science and Business Media LLC
Reference12 articles.
1. Derval N, Takigawa M, Frontera A, Mahida S, Konstantinos V, Denis A, et al. Characterization of Complex Atrial Tachycardia in Patients With Previous Atrial Interventions Using High-Resolution Mapping. JACC: Clin Electrophysiol. 2020;6(7):815–26.
2. Frontera A, Mahajan R, Dallet C, Vlachos K, Kitamura T, Takigawa M, et al. Characterizing localized reentry with high-resolution mapping: evidence for multiple slow conducting isthmuses within the circuit. Heart Rhythm. 2019;16(5):679–85.
3. Frontera A, Takigawa M, Martin R, Thompson N, Cheniti G, Massoullié G, et al. Electrogram signature of specific activation patterns: analysis of atrial tachycardias at high-density endocardial mapping. Heart Rhythm. 2018;15(1):28–37.
4. Laţcu DG, Bun S-S, Viera F, Delassi T, El Jamili M, Al Amoura A, et al. Selection of critical isthmus in scar-related atrial tachycardia using a new automated ultrahigh resolution mapping system. Circ: Arrhythmia and Electrophysiology. 2017;10(1):e004510.
5. Ciaccio EJ, Coromilas J, Wit AL, Peters NS, Garan H. Source-Sink Mismatch Causing Functional Conduction Block in Re-Entrant Ventricular Tachycardia. JACC Clin Electrophysiol. 2018;4(1):1–16.