Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: Identification and ablation of the mid-diastolic isthmus

Roberto De Ponti, Roberto Verlato, Emanuele Bertaglia, Maurizio Del Greco, Antonio Fusco, Nicola Bottoni, Fabrizio Drago, Luigi Sciarra, Renato Ometto, Roberto Mantovan, Jorge A. Salerno-Uriarte

Research output: Contribution to journalArticle

Abstract

Aims: This multicentre prospective study evaluated the ability of electroanatomic mapping (EAM) using a specific parameter setting to identify clearly the mid-diastolically activated isthmus (MDAI) and guide ablation of macro-re-entrant atrial tachycardia (MAT). Methods and results: Consecutive patients with MAT, different from typical isthmus-dependent atrial flutter, were enrolled. EAM was performed using a specific setting of the window of interest, calculated to identify the MDAI and guide ablation of this area. Sixty-five patients exhibiting 81 MATs (mean cycle length 308 ± 68 ms) were considered. Thirty-two (49.2%) had previous heart surgery. In 79 of 81 morphologies (97.5%), EAM reconstructed 95.9 ± 4.3% of the tachycardia circuit and identified the MDAI; 23 of the 79 morphologies (29.1%) were double-loop re-entry. Mapping of two morphologies was incomplete due to MAT termination after catheter bumping. In 73 of 79 mapped morphologies (92.4%), abolition of the MAT was obtained by 13.2 ± 12.4 applications. During the 14 ± 4 month follow-up, MAT recurred in 4 of the successfully treated patients (6.8%). Conclusion: EAM using a specific parameter setting proved highly effective at identifying the MDAI in MAT, even in patients with previous surgery and multiple re-entrant loops. Ablation of the MDAI yielded acute arrhythmia suppression with low rate of recurrence during follow-up.

Original languageEnglish
Pages (from-to)449-457
Number of pages9
JournalEuropace
Volume9
Issue number7
DOIs
Publication statusPublished - Jul 2007

Keywords

  • Catheter ablation of supraventricular arrhythmias
  • Electroanatomic mapping
  • Macro-re-entrant atrial tachycardia
  • Macro-re-entry

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    De Ponti, R., Verlato, R., Bertaglia, E., Del Greco, M., Fusco, A., Bottoni, N., Drago, F., Sciarra, L., Ometto, R., Mantovan, R., & Salerno-Uriarte, J. A. (2007). Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: Identification and ablation of the mid-diastolic isthmus. Europace, 9(7), 449-457. https://doi.org/10.1093/europace/eum055