A deductive mapping strategy for atrial tachycardia following atrial fibrillation ablation: importance of localized reentry
Abstract
BACKGROUND: Atrial tachycardia (AT) occurring following catheter ablation of persistent atrial fibrillation (AF) may be challenging to map and ablate because their mechanism and location is unpredictable and may be multiple in an individual patient. METHODS AND RESULTS: A prospective cohort of 128 consecutive patients presenting 246 AT in the context of prior AF ablation was investigated. Using activation and entrainment mapping and applying the consensus definition of AT, we evaluated a deductive diagnostic approach based on up to three steps: (1) cycle length regularity, (2) search for macroreentry (i.e., involving >2 separate atrial segments), and (3) if macroreentry excluded, search for focal origin giving a centrifugal activation of the atria. A total of 238/246 (97%) sustained AT (mean cycle length [CL] 284 +/- 87 ms) were successfully mapped (single AT, 51 pts; multiple AT, 77 pts) with a diagnostic time of 10 +/- 8 min per tachycardia. AT were macroreentrant in 109 (46%) and focal in 129 (54%). Of the latter, only 34 focal AT originated from a discrete point site fulfilling the consensus criteria, while a distinct mechanism, localized reentry (AT that was neither macro reentry nor focal), was identified in 95. Localized reentry was defined by (1) electrograms covering >or=75% of the cycle length of AT within an area covering a single or 2 contiguous segments, (2) postpacing interval (PPI) < 30 ms at the site, (3) an identifiable zone of slow conduction, and (4) centrifugal activation of the atrium from the area. CONCLUSIONS: This prospective study demonstrates the feasibility of rapid and accurate identification of all types of postablation AT in a large cohort of patients and describes the dominant role of localized reentry as a novel mechanism of AT.
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If irregularity does not exceed 15% of the cycle length, a reentry is possible, while above this threshold, a focal arrhythmia is much more likely.
“If the irregularity does not exceed 15% of the CL, a reentry is possible, while above this threshold, a focal arrhythmia is much more likely.18”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [18]
Three circuits (cavotricuspid isthmus in the RA, perimitral or roof dependent in the LA) are responsible for more than 90% of macroreentries.
“Three circuits (cavotricuspid isthmus in the RA, perimitral or roof dependent in the LA) are responsible for more than 90% of macroreentries.18”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [18]
In centrifugal arrhythmias such as focal AT and localized reentry, activation originates from a source and spreads centrifugally; in macro-reentries, activation follows a large path around a central obstacle and reenters.
“In centrifugal arrhythmias, (such as focal AT and localized reentry) the activation originates from a source and spreads centrifugally to the rest of the atria, while in macro-reentries, it follows a large path around a central obstacle and reenters.18”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [18]
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- Authors
- JAÏS, P., MATSUO, S., KNECHT, S., WEERASOORIYA, R., HOCINI, M., SACHER, F., WRIGHT, M., NAULT, I., LELLOUCHE, N., KLEIN, G., CLÉMENTY, J., & HAÏSSAGUERRE, M.
- Affiliations
- Université de Bordeaux (FR)
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2009-04-21
- Volume
- 20
- Issue
- 5
- Pages
- 480-491
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2069873093
- Cited by
- 255
- References
- 31
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 4 · 2023: 7 · 2022: 14 · 2021: 11 · 2020: 21 · 2019: 15 · 2018: 14 · 2017: 20 · 2016: 12 · 2015: 13 · 2014: 12 · 2013: 26 · 2012: 31
- FWCI
- 10.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial tachycardia, atrial fibrillation ablation, macroreentry, focal atrial tachycardia, activation mapping, entrainment mapping, slow conduction zone
- MeSH terms
- Algorithms, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Tachycardia, Ectopic Atrial, Treatment Outcome, Catheter Ablation, Body Surface Potential Mapping, Surgery, Computer-Assisted
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