Detalle Publicación

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

Autores: De-Simone, A.; Anselmino, M.; Scaglione, M.; Stabile, G.; Solimene, F.; De-Bellis, A.; Pepe, M.; Panella, A.; Ferraris, F.; Malacrida, M.; Maddaluno, F.; Gaita, F.; García Bolao, José Ignacio
ISSN: 1558-2027
Volumen: 21
Número: 2
Páginas: 113 - 122
Fecha de publicación: 2020
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.