Mapping and ablation of left atrial roof-dependent tachycardias using an ultra-high resolution mapping system
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Published:2022-02-16
Issue:1
Volume:22
Page:
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ISSN:1471-2261
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Container-title:BMC Cardiovascular Disorders
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language:en
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Short-container-title:BMC Cardiovasc Disord
Author:
Miyazaki ShinsukeORCID, Hasegawa Kanae, Yamao Kazuya, Ishikawa Eri, Mukai Moe, Aoyama Daisetsu, Nodera Minoru, Yamaguchi Junya, Shiomi Yuichiro, Tama Naoto, Ikeda Hiroyuki, Fukuoka Yoshitomo, Ishida Kentaro, Uzui Hiroyasu, Iesaka Yoshito, Tada Hiroshi
Abstract
Abstract
Background
Left atrial roof-dependent tachycardias (LARTs) are common macroreentrant atrial tachycardias (ATs). We sought to characterize clinical LARTs using an ultra-high resolution mapping system.
Methods
This study included 22 consecutive LARTs in 21 patients who underwent AT mapping/ablation using Rhythmia systems.
Results
Three, 13, 4, and 2 LART patients were cardiac intervention naïve (Group-A), post-roof line ablation (Group-B), post-atrial fibrillation ablation without linear ablation (Group-C), and post-cardiac surgery (Group-D), respectively. The mean AT cycle length was 244 ± 43 ms. Coronary sinus activation was proximal-to-distal or distal-to-proximal in 16 (72.7%) ATs. The activation map revealed 13 (59.1%) clockwise and 9 (40.9%) counter-clockwise LARTs. A 12-lead synchronous isoelectric interval was observed in 10/19 (52.6%) LARTs. The slow conduction area was identified on the LA roof, anterior/septal wall, and posterior wall in 18, 6, and 2 ATs, respectively. Twenty concomitant ATs among 13 procedures were also eliminated, and peri-mitral AT coexisted in 7 of 9 non-group-B patients. In group-B, the conduction gap was predominantly located on the mid-roof. Sustained LARTs were terminated by a single application and linear ablation in 6 (27.3%) and 9 (40.9%), while converting to other ATs in 7 (31.8%) LARTs. Complete linear block was created without any complications in all, however, ablation at the mid-posterior wall was required to achieve block in 4 (18.2%) procedures. During 14.0 (6.5–28.5) months of follow-up, 17 (81.0%) and 19 (90.5%) patients were free from any atrial tachyarrhythmias after single and last procedures.
Conclusions
The LART mechanisms were distinct in individual patients, and elimination of all concomitant ATs was required for the management.
Funder
Ministry of Health, Labour and Welfare
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine
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