Key result
Cycle length variation <24 ms differentiates re-entrant from focal atrial tachycardias with ~97% sensitivity.
Why the study?
It would be helpful if the mechanism and circuit of an atrial tachycardia could be predicted before initiating high-resolution mapping.
Does detailed analysis of tachycardia cycle length predict the mechanism and location of atrial tachycardias in patients undergoing ablation?
Observational (n=95)
Yes
Does detailed analysis of tachycardia cycle length predict the mechanism and location of atrial tachycardias in patients undergoing ablation?
Answers are grounded in this paper and cite their sources.
Detailed analysis of tachycardia cycle length, including variation and respiration correlation, can accurately predict the mechanism and chamber of origin of atrial tachycardias prior to high-resolution mapping.
AIMS: Although the mechanism of an atrial tachycardia (AT) can usually be elucidated using modern high-resolution mapping systems, it would be helpful if the AT mechanism and circuit could be predicted before initiating mapping. OBJECTIVE: We examined if the information gathered from the cycle length (CL) of the tachycardia can help predict the AT-mechanism and its localization. METHODS: One hundred and thirty-eight activation maps of ATs including eight focal-ATs, 94 macroreentrant-ATs, and 36 localized-ATs in 95 patients were retrospectively reviewed. Maximal CL (MCL) and minimal CL (mCL) over a minute period were measured via a decapolar catheter in the coronary sinus. CL-variation and beat-by-beat CL-alternation were examined. Additionally, the CL-respiration correlation was analysed by the RhythmiaTM system. : Both MCL and mCL were significantly shorter in macroreentrant-ATs [MCL = 288 (253-348) ms, P = 0.0001; mCL = 283 (243-341) ms, P = 0.0012], and also shorter in localized-ATs [MCL = 314 (261-349) ms, P = 0.0016; mCL = 295 (248-340) ms, P = 0.0047] compared to focal-ATs [MCL = 506 (421-555) ms, mCL = 427 (347-508) ms]. An absolute CL-variation (MCL-mCL) < 24 ms significantly differentiated re-entrant ATs from focal-ATs with a sensitivity = 96.9%, specificity = 100%, positive predictive value (PPV) = 100%, and negative predictive value (NPV) = 66.7%. The beat-by-beat CL-alternation was observed in 10/138 (7.2%), all of which showed the re-entrant mechanism, meaning that beat-by-beat CL-alternation was the strong sign of re-entrant mechanism (PPV = 100%). Although the CL-respiration correlation was observed in 28/138 (20.3%) of ATs, this was predominantly in right-atrium (RA)-ATs (24/41, 85.7%), rather than left atrium (LA)-ATs (4/97, 4.1%). A positive CL-respiration correlation highly predicted RA-ATs (PPV = 85.7%), and negative CL-respiration correlation probably suggested LA-ATs (NPV = 84.5%). CONCLUSION: Detailed analysis of the tachycardia CL helps predict the AT-mechanism and the active AT chamber before an initial mapping.
No takes yet. Share an insight, caveat, or question.
Takigawa et al. (2023) conducted an observational in Atrial tachycardia (n=95). Tachycardia cycle length (CL) parameters vs. Focal vs re-entrant mechanisms was evaluated on Differentiation of re-entrant ATs from focal-ATs using absolute CL-variation < 24 ms (Sensitivity 96.9%, Specificity 100%). An absolute cycle length variation of <24 ms accurately differentiated re-entrant atrial tachycardias from focal atrial tachycardias with 96.9% sensitivity and 100% specificity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: