Atrial pace mapping using automatic intracardiac pattern matching for ablation of non-sustained atrial tachycardia: a case report

Figures

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  Figure 1. Atrial pace mapping workflow. A: Clinical AT episodes recorded by the smartwatch. Note the on/off phenomenon and variable cycle length (a short run with a variable cycle of 510–420 ms and a sustained episode with a stable cycle of 420 ms) and 1-to-1 atrioventricular conduction, suggestive of the ectopic character of the tachycardia. B: Fluoroscopic positions of the referent catheters in the CS and HRA. Three electrodes of the CS catheter and three of the HRA catheter are connected to the precordial leads to acquire the unipolar signals for the EnsiteX ECG pattern algorithm. C: Acquisition of the intracardiac unipolar signals during atrial tachycardia with 1-to-1 atrioventricular conduction and a cycle length of 420 ms induced by programmed atrial pacing with isoproterenol infusion. V1–V3 leads represent the signals from the CS catheter, and V4-V6 leads correspond to the signals from the HRA catheter. D: A setup for the pattern-matching score map using only V1–V6 leads representing the unipolar signals from the double-chamber referent. The reference trigger is set to the minimal deflection of the V4 (HRAd). This way, the trigger will align the referent with paced pattern windows.…

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  Figure 2. A: Local activation time map of the atrial tachycardia performed before bumping. The region above the earliest activation site (encircled by the black line) is not mapped. B: A score map created by atrial pace mapping with a double chamber reference and representative examples of different degrees of intracardiac pattern matching. Note the relatively low best matching score but a small area (0.1 cm2) of the top 10% strata. Moderate matching scores inside the encircled area excluded the origin there. C: A score map created by atrial pace mapping with a single chamber reference and representative examples of different degrees of intracardiac pattern matching. Note the high pattern similarity score’s large (>7 cm2) area. AT = atrial tachycardia; CS = coronary sinus; HRA = high right atrium; LAT = local activation time; LRA = low right atrium.

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  Supplemental Figure 1.