Key result
Electroanatomical mapping using CARTO successfully identified reentrant and focal mechanisms, guiding catheter ablation that eliminated 11 of 13 (84.6%) incisional atrial tachycardias.
Why the study?
Does electroanatomical mapping (CARTO) facilitate the identification and successful ablation of incisional atrial tachycardias in post-cardiac surgery patients?
Observational (n=10)
Does electroanatomical mapping (CARTO) facilitate the identification and successful ablation of incisional atrial tachycardias in post-cardiac surgery patients?
Three-dimensional electroanatomical mapping effectively visualizes activation wavefronts to identify the mechanisms of incisional atrial tachycardias, facilitating successful targeted catheter ablation.
Answers are grounded in this paper and cite their sources.
CARTO mapping may guide ablation in complex incisional tachycardias; leaves open routine use pending controlled trials.
AIMS: Incisional atrial tachycardias in patients following surgery for congenital heart disease are based on complex structural abnormalities in these hearts. The aim of this study was to evaluate the use of the electroanatomical mapping system, CARTO, in consecutive patients with different forms of incisional atrial tachycardia. METHODS AND RESULTS: The electroanatomical mapping system combines electrophysiological and spatial information and allows visualization of atrial activation in a three-dimensional anatomical reconstruction of the atria. Electroanatomical mapping of right atrial activation was performed in 10 patients after surgery for congenital heart disease, surgery for Wolff-Parkinson-White syndrome, or heart transplantation presenting with 13 incisional atrial tachycardias. The three-dimensional mapping allowed a rapid distinction between focal (n=3) and reentrant mechanisms (n=10) and visualization of the activation wavefronts along anatomical and surgically created barriers. Electroanatomical activation maps (mean right atrial activation time 213+/-107 ms) were constructed with 89+/-60 catheter positions during an average mapping time of 48+/-33 min. Reentrant tachycardias propagating through the tricuspid annulus-vena cava inferior isthmus (n=6) or along periatriotomy loops (n=4) were identified in eight patients. Ectopic atrial foci near surgical scars could be localized in three patients. Catheter ablation by creation of a lesion in a critical isthmus of conduction or by targeting the arrhythmogenic focus eliminated 11 of 13 incisional atrial tachycardias. CONCLUSION: Visualization of atrial activation in a three-dimensional reconstruction of the right atrium using the electroanatomical mapping system CARTO facilitates understanding of the mechanism and defines the reentrant circuits of incisional atrial tachycardias. This new method may improve the success rate of electrophysiologically guided and anatomically guided catheter ablation of incisional atrial tachycardias.
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Christopher Reithmann (2001) conducted an observational in Incisional atrial tachycardias (n=10). Electroanatomical mapping system (CARTO) was evaluated on Elimination of incisional atrial tachycardias by catheter ablation. Electroanatomical mapping using CARTO successfully identified reentrant and focal mechanisms, guiding catheter ablation that eliminated 11 of 13 (84.6%) incisional atrial tachycardias.
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