Key result
Mapping and ablation of left atrial roof-dependent tachycardias using an ultra-high resolution mapping system resulted in 90.5% of patients being free from any atrial tachyarrhythmias after the last procedure.
Why the study?
Left atrial roof-dependent tachycardias are common macroreentrant atrial tachycardias, motivating their characterization using an ultra-high resolution mapping system.
Observational (n=21)
No
Ultra-high resolution mapping successfully identified the critical isthmus of left atrial roof-dependent tachycardias, leading to a 90.5% freedom from atrial tachyarrhythmias after the last procedure.
May aid isthmus identification in roof-dependent tachycardias; leaves open superiority over conventional mapping in randomized trials.
BACKGROUND: Left atrial roof-dependent tachycardias (LARTs) are common macroreentrant atrial tachycardias (ATs). We sought to characterize clinical LARTs using an ultra-high resolution mapping system. METHODS: This study included 22 consecutive LARTs in 21 patients who underwent AT mapping/ablation using Rhythmia systems. RESULTS: Three, 13, 4, and 2 LART patients were cardiac intervention naïve (Group-A), post-roof line ablation (Group-B), post-atrial fibrillation ablation without linear ablation (Group-C), and post-cardiac surgery (Group-D), respectively. The mean AT cycle length was 244 ± 43 ms. Coronary sinus activation was proximal-to-distal or distal-to-proximal in 16 (72.7%) ATs. The activation map revealed 13 (59.1%) clockwise and 9 (40.9%) counter-clockwise LARTs. A 12-lead synchronous isoelectric interval was observed in 10/19 (52.6%) LARTs. The slow conduction area was identified on the LA roof, anterior/septal wall, and posterior wall in 18, 6, and 2 ATs, respectively. Twenty concomitant ATs among 13 procedures were also eliminated, and peri-mitral AT coexisted in 7 of 9 non-group-B patients. In group-B, the conduction gap was predominantly located on the mid-roof. Sustained LARTs were terminated by a single application and linear ablation in 6 (27.3%) and 9 (40.9%), while converting to other ATs in 7 (31.8%) LARTs. Complete linear block was created without any complications in all, however, ablation at the mid-posterior wall was required to achieve block in 4 (18.2%) procedures. During 14.0 (6.5-28.5) months of follow-up, 17 (81.0%) and 19 (90.5%) patients were free from any atrial tachyarrhythmias after single and last procedures. CONCLUSIONS: The LART mechanisms were distinct in individual patients, and elimination of all concomitant ATs was required for the management.
No takes yet. Share an insight, caveat, or question.
Miyazaki et al. (2022) conducted an observational in Left atrial roof-dependent tachycardias (n=21). Mapping and ablation using Rhythmia ultra-high resolution mapping system was evaluated on Freedom from any atrial tachyarrhythmias after the last procedure. Mapping and ablation of left atrial roof-dependent tachycardias using an ultra-high resolution mapping system resulted in 90.5% of patients being free from any atrial tachyarrhythmias after the last procedure.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: