Key result
Ablation of slow conduction areas during sinus rhythm is linked to ~76% arrhythmia freedom.
Why the study?
Identifying the critical isthmus for atrial tachycardia often requires mapping during tachycardia; whether sinus rhythm mapping can reliably detect and eliminate slow conduction zones predisposing to atrial tachycardia was unknown.
Does high-density mapping and ablation of slow conduction zones during sinus rhythm prevent arrhythmia recurrence in patients with atrial tachycardia?
Observational (n=37)
Does high-density mapping and ablation of slow conduction zones during sinus rhythm prevent arrhythmia recurrence in patients with atrial tachycardia?
High-density mapping and ablation of slow conduction zones during sinus rhythm is an effective strategy for treating atrial tachycardia, potentially eliminating the need for mapping during tachycardia.
May support SR ablation with non-inducibility testing for AT; leaves open randomized confirmation before practice change.
Background Identifying the critical isthmus (CI) for atrial tachycardia (AT) often requires mapping during tachycardia. This study investigates whether sinus rhythm (SR) mapping can reliably detect and eliminate all potential slow conduction zones predisposing to AT. Methods Patients with a history of AT (focal or reentrant) who underwent catheter ablation with 3D high-density mapping were enrolled. Activation and voltage mapping was performed during AT, with SR restored by overdrive pacing or cardioversion when necessary. SR voltage maps (n=32) and paced maps from crista terminalis (n=5) with cutoff values of 0.05 mV to 0.5 mV were then obtained and compared to AT maps to identify CI, defined by electrograms with diastolic potentials and prolonged, fragmented morphology at slow conduction sites with optimal post-pacing interval (PPI). Ablation targeted these slow conduction areas during SR, with procedural success confirmed by acute AT non-inducibility and follow-up. Results Thirty-seven patients (mean age: 70.80 ± 9, 16 (43.24%) female, 23 Redo procedures) presented with AT. Voltage mapping during AT revealed a mean value of bipolar voltage (including both the near-field and far-field components), near-field and far-field EGM duration of 0.26 ± 0.27 mV and 95.79 ± 40.19 ms at CI. The mean value of bipolar voltage (near-field and far-field component), near-field and far-field EGM duration during SR corresponding to CI in AT were 0.31 ± 0.21 mV and 86.30 ± 31.30 ms, respectively. SR voltage maps reliably identified CIs, showing prolonged, fractionated EGMs with low bipolar voltage. Ablation during SR achieved AT non-inducibility in all cases, with arrhythmia freedom in 28/37 (75.68%) cases at mean follow up of 7.14 month. Conclusion The findings demonstrate that targeting conduction abnormalities during SR is sufficient for procedural success, eliminating the need for successive tachycardia induction, mapping and ablation.
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Hess et al. (2026) conducted an observational in Atrial tachycardia (n=37). High-density mapping and ablation during sinus rhythm was evaluated on Arrhythmia freedom at follow-up. Ablation targeting slow conduction areas identified during sinus rhythm achieved acute atrial tachycardia non-inducibility in 100% of cases and arrhythmia freedom in 75.68% at 7.14 months.
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