A strategy combining high-density activation mapping and entrainment mapping successfully terminated 96% (25 of 26) of targeted atrial tachycardias developing after atrial fibrillation ablation.
Observational (n=17)
Does a strategy combining high-density activation mapping and entrainment mapping successfully terminate atrial tachycardia after atrial fibrillation ablation?
A strategy combining rapid high-density activation mapping with entrainment mapping is highly effective for identifying and eliminating scar-related atrial tachycardias following atrial fibrillation ablation.
BACKGROUND: Atrial tachycardia (AT) that develops after ablation of atrial fibrillation often poses a more difficult clinical situation than the index arrhythmia. This study details the use of an impedance-based electroanatomic mapping system (Ensite NavX) in concert with a specialized multielectrode mapping catheter for rapid, high-density atrial mapping. In this study, this activation mapping was combined with entrainment mapping to eliminate ATs developing late after atrial fibrillation ablation. METHODS AND RESULTS: All study patients developed AT after ablation for atrial fibrillation. The approach to AT ablation consisted of 4 steps: use of a 20-pole penta-array catheter to map the chamber rapidly during the rhythm of interest, analysis of the patterns of atrial activation to identify wave fronts of electric propagation, targeted entrainment at putative channels, and catheter ablation at these "isthmuses." All ablations were performed with irrigated radiofrequency ablation catheters. Forty-one ATs were identified in 17 patients (2.4+/-1.6 ATs per patient). Using the multielectrode catheter in conjunction with the Ensite NavX system, we created activation maps of 33 of 41 ATs (81%) (mean cycle length, 284+/-71 seconds) with a mean of 365+/-108 points per map and an average mapping time of 8+/-3 minutes. Of the 33 mapped ATs, 7 terminated either spontaneously or during entrainment maneuvers. Radiofrequency energy was used to attempt ablation of 26 ATs; 25 of 26 of the ATs (96%) were terminated successfully by ablation or catheter pressure. CONCLUSIONS: This study demonstrates a strategy for rapidly defining and eliminating the scar-related ATs typically encountered after ablation of atrial fibrillation.
Patel et al. (Tue,) conducted a observational in Atrial tachycardia after atrial fibrillation ablation (n=17). High-density activation mapping (Ensite NavX) and entrainment mapping followed by radiofrequency ablation was evaluated on Successful termination of atrial tachycardia by ablation or catheter pressure. A strategy combining high-density activation mapping and entrainment mapping successfully terminated 96% (25 of 26) of targeted atrial tachycardias developing after atrial fibrillation ablation.
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