Characterization of Focal Atrial Tachycardia Using High-Density Mapping
Characterization of Focal Atrial Tachycardia Using High-Density Mapping Prashanthan Sanders, Mélèze Hocini, Pierre Jaïs, Li-Fern Hsu, Yoshihide Takahashi, Martin Rotter, Christophe Scavée, Jean-Luc Pasquié, Fréderic Sacher, Thomas Rostock, Chrishan J. Nalliah, Jacques Cleménty, Michel Haïssaguerre F...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2005-12, Vol.46 (11), p.2088-2099 |
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| creator | Sanders, Prashanthan Hocini, Mélèze Jaïs, Pierre Hsu, Li-Fern Takahashi, Yoshihide Rotter, Martin Scavée, Christophe Pasquié, Jean-Luc Sacher, Fréderic Rostock, Thomas Nalliah, Chrishan J. Clémenty, Jacques Haïssaguerre, Michel |
| description | Characterization of Focal Atrial Tachycardia Using High-Density Mapping
Prashanthan Sanders, Mélèze Hocini, Pierre Jaïs, Li-Fern Hsu, Yoshihide Takahashi, Martin Rotter, Christophe Scavée, Jean-Luc Pasquié, Fréderic Sacher, Thomas Rostock, Chrishan J. Nalliah, Jacques Cleménty, Michel Haïssaguerre
Focal atrial tachycardias are characterized by atrial activity that originates from a small area (focus) and spreads out centrifugally. Mapping to identify these focal arrhythmias can be difficult. In this study, the role of high-density localized mapping to identify and characterize the origin of focal atrial tachycardia is evaluated. High-density localized mapping enables rapid vector mapping to identify the site of earliest activation. Localized mapping at the origin of some of these apparently “focal” atrial tachycardias demonstrated localized re-entry.
The goal of this study was to characterize the origin of focal atrial tachycardias (AT).
Focal ATs originate from a small area and spread centrifugally; however, activation at the AT origin has not been characterized.
Twenty patients with AT having failed prior ablation or occurring after atrial fibrillation ablation were studied. After excluding macro–re-entry, AT was mapped using a 20-pole catheter (five radiating spines; diameter 3.5 cm), performing vector mapping to identify the earliest activity followed by high-density mapping at the AT origin. Localized re-entry was considered if >85% of the tachycardia cycle length (CL) was observed within the mapping field and was confirmed by entrainment.
A total of 27 ATs were mapped to the pulmonary vein ostia (n = 5), and left (n = 16) and right atria (n = 6). A localized focus was evidenced at the site of origin in 19 ATs (70%), whereas in 8 (30%), localized re-entry was evidenced by 95.2 ± 4.5% of the tachycardia CL recorded within the mapping field and entrainment showed a post-pacing interval |
| doi_str_mv | 10.1016/j.jacc.2005.08.044 |
| format | Article |
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Prashanthan Sanders, Mélèze Hocini, Pierre Jaïs, Li-Fern Hsu, Yoshihide Takahashi, Martin Rotter, Christophe Scavée, Jean-Luc Pasquié, Fréderic Sacher, Thomas Rostock, Chrishan J. Nalliah, Jacques Cleménty, Michel Haïssaguerre
Focal atrial tachycardias are characterized by atrial activity that originates from a small area (focus) and spreads out centrifugally. Mapping to identify these focal arrhythmias can be difficult. In this study, the role of high-density localized mapping to identify and characterize the origin of focal atrial tachycardia is evaluated. High-density localized mapping enables rapid vector mapping to identify the site of earliest activation. Localized mapping at the origin of some of these apparently “focal” atrial tachycardias demonstrated localized re-entry.
The goal of this study was to characterize the origin of focal atrial tachycardias (AT).
Focal ATs originate from a small area and spread centrifugally; however, activation at the AT origin has not been characterized.
Twenty patients with AT having failed prior ablation or occurring after atrial fibrillation ablation were studied. After excluding macro–re-entry, AT was mapped using a 20-pole catheter (five radiating spines; diameter 3.5 cm), performing vector mapping to identify the earliest activity followed by high-density mapping at the AT origin. Localized re-entry was considered if >85% of the tachycardia cycle length (CL) was observed within the mapping field and was confirmed by entrainment.
A total of 27 ATs were mapped to the pulmonary vein ostia (n = 5), and left (n = 16) and right atria (n = 6). A localized focus was evidenced at the site of origin in 19 ATs (70%), whereas in 8 (30%), localized re-entry was evidenced by 95.2 ± 4.5% of the tachycardia CL recorded within the mapping field and entrainment showed a post-pacing interval <20 ms longer than tachycardia CL (6 of 6 tested). Localized re-entry had a shorter CL (p = 0.009), slowed conduction at its origin (fractionated potential 115 ± 19 ms vs. 64 ± 22 ms, representing 49 ± 10% and 20 ± 10% of tachycardia CL, respectively; p < 0.0001), and were more often contiguous with regions of electrical silence or conduction abnormalities (88% vs. 32%; p = 0.01). In addition, mapping documented varying degrees of intra-atrial conduction block, preferential conduction (n = 5), and rapid bursts of myocardial activity (n = 1). At 11 ± 7 months, none have had recurrence of AT.
High-density multielectrode mapping can be used to perform vector mapping to localize complex AT. It provides novel insight into the mechanisms of focal AT, distinguishing focal AT from localized re-entry.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2005.08.044</identifier><identifier>PMID: 16325047</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiac Catheterization - instrumentation ; Cardiac dysrhythmias ; Cardiology ; Cardiology. Vascular system ; Catheter Ablation ; Catheters ; Electrocardiography ; Electrodes ; Electrophysiologic Techniques, Cardiac - instrumentation ; Electrophysiologic Techniques, Cardiac - methods ; Equipment Design ; Female ; Heart ; Heart Atria - physiopathology ; Humans ; Male ; Medical sciences ; Middle Aged ; Studies ; Tachycardia - physiopathology ; Tachycardia - surgery</subject><ispartof>Journal of the American College of Cardiology, 2005-12, Vol.46 (11), p.2088-2099</ispartof><rights>2005 American College of Cardiology Foundation</rights><rights>2006 INIST-CNRS</rights><rights>Copyright Elsevier Limited Dec 6, 2005</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c558t-3ccd75bf42971092cb8c38cf6de4b8aeece45385c365c5ab7a3a7d3db6b1b57e3</citedby><cites>FETCH-LOGICAL-c558t-3ccd75bf42971092cb8c38cf6de4b8aeece45385c365c5ab7a3a7d3db6b1b57e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109705022011$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17300678$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16325047$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sanders, Prashanthan</creatorcontrib><creatorcontrib>Hocini, Mélèze</creatorcontrib><creatorcontrib>Jaïs, Pierre</creatorcontrib><creatorcontrib>Hsu, Li-Fern</creatorcontrib><creatorcontrib>Takahashi, Yoshihide</creatorcontrib><creatorcontrib>Rotter, Martin</creatorcontrib><creatorcontrib>Scavée, Christophe</creatorcontrib><creatorcontrib>Pasquié, Jean-Luc</creatorcontrib><creatorcontrib>Sacher, Fréderic</creatorcontrib><creatorcontrib>Rostock, Thomas</creatorcontrib><creatorcontrib>Nalliah, Chrishan J.</creatorcontrib><creatorcontrib>Clémenty, Jacques</creatorcontrib><creatorcontrib>Haïssaguerre, Michel</creatorcontrib><title>Characterization of Focal Atrial Tachycardia Using High-Density Mapping</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Characterization of Focal Atrial Tachycardia Using High-Density Mapping
Prashanthan Sanders, Mélèze Hocini, Pierre Jaïs, Li-Fern Hsu, Yoshihide Takahashi, Martin Rotter, Christophe Scavée, Jean-Luc Pasquié, Fréderic Sacher, Thomas Rostock, Chrishan J. Nalliah, Jacques Cleménty, Michel Haïssaguerre
Focal atrial tachycardias are characterized by atrial activity that originates from a small area (focus) and spreads out centrifugally. Mapping to identify these focal arrhythmias can be difficult. In this study, the role of high-density localized mapping to identify and characterize the origin of focal atrial tachycardia is evaluated. High-density localized mapping enables rapid vector mapping to identify the site of earliest activation. Localized mapping at the origin of some of these apparently “focal” atrial tachycardias demonstrated localized re-entry.
The goal of this study was to characterize the origin of focal atrial tachycardias (AT).
Focal ATs originate from a small area and spread centrifugally; however, activation at the AT origin has not been characterized.
Twenty patients with AT having failed prior ablation or occurring after atrial fibrillation ablation were studied. After excluding macro–re-entry, AT was mapped using a 20-pole catheter (five radiating spines; diameter 3.5 cm), performing vector mapping to identify the earliest activity followed by high-density mapping at the AT origin. Localized re-entry was considered if >85% of the tachycardia cycle length (CL) was observed within the mapping field and was confirmed by entrainment.
A total of 27 ATs were mapped to the pulmonary vein ostia (n = 5), and left (n = 16) and right atria (n = 6). A localized focus was evidenced at the site of origin in 19 ATs (70%), whereas in 8 (30%), localized re-entry was evidenced by 95.2 ± 4.5% of the tachycardia CL recorded within the mapping field and entrainment showed a post-pacing interval <20 ms longer than tachycardia CL (6 of 6 tested). Localized re-entry had a shorter CL (p = 0.009), slowed conduction at its origin (fractionated potential 115 ± 19 ms vs. 64 ± 22 ms, representing 49 ± 10% and 20 ± 10% of tachycardia CL, respectively; p < 0.0001), and were more often contiguous with regions of electrical silence or conduction abnormalities (88% vs. 32%; p = 0.01). In addition, mapping documented varying degrees of intra-atrial conduction block, preferential conduction (n = 5), and rapid bursts of myocardial activity (n = 1). At 11 ± 7 months, none have had recurrence of AT.
High-density multielectrode mapping can be used to perform vector mapping to localize complex AT. It provides novel insight into the mechanisms of focal AT, distinguishing focal AT from localized re-entry.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac Catheterization - instrumentation</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Catheter Ablation</subject><subject>Catheters</subject><subject>Electrocardiography</subject><subject>Electrodes</subject><subject>Electrophysiologic Techniques, Cardiac - instrumentation</subject><subject>Electrophysiologic Techniques, Cardiac - methods</subject><subject>Equipment Design</subject><subject>Female</subject><subject>Heart</subject><subject>Heart Atria - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Studies</subject><subject>Tachycardia - physiopathology</subject><subject>Tachycardia - surgery</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1r20AQhpfQkLhp_0APRVCam5RdrfbD0EtwvgoOuTjnZTQaxStsyd2VC86vz7o2BHLoaWB4ZublGca-CV4ILvRVV3SAWJScq4LbglfVCZsIpWwu1dR8YhNupMoFn5pz9jnGjnOurZiesXOhZal4ZSbsfraEADhS8K8w-qHPhja7GxBW2fUYfCoLwOUOITQesufo-5fswb8s8xvqox932SNsNqn5hZ22sIr09Vgv2PPd7WL2kM-f7n_Pruc5plxjLhEbo-q2KqcmBSuxtigttrqhqrZAhFQpaRVKrVBBbUCCaWRT61rUypC8YJeHvZsw_NlSHN3aR6TVCnoattFpa7WojErgjw9gN2xDn7I5obgWWmtjE1UeKAxDjIFatwl-DWHnBHd7ya5ze8luL9lx65LkNPT9uHpbr6l5HzlaTcDPIwAxmWwD9OjjO2dk-sS_678OHCVjfz0FF9FTj9T4QDi6ZvD_y_EGtNOZ4g</recordid><startdate>20051206</startdate><enddate>20051206</enddate><creator>Sanders, Prashanthan</creator><creator>Hocini, Mélèze</creator><creator>Jaïs, Pierre</creator><creator>Hsu, Li-Fern</creator><creator>Takahashi, Yoshihide</creator><creator>Rotter, Martin</creator><creator>Scavée, Christophe</creator><creator>Pasquié, Jean-Luc</creator><creator>Sacher, Fréderic</creator><creator>Rostock, Thomas</creator><creator>Nalliah, Chrishan J.</creator><creator>Clémenty, Jacques</creator><creator>Haïssaguerre, Michel</creator><general>Elsevier Inc</general><general>Elsevier Science</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20051206</creationdate><title>Characterization of Focal Atrial Tachycardia Using High-Density Mapping</title><author>Sanders, Prashanthan ; Hocini, Mélèze ; Jaïs, Pierre ; Hsu, Li-Fern ; Takahashi, Yoshihide ; Rotter, Martin ; Scavée, Christophe ; Pasquié, Jean-Luc ; Sacher, Fréderic ; Rostock, Thomas ; Nalliah, Chrishan J. ; Clémenty, Jacques ; Haïssaguerre, Michel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c558t-3ccd75bf42971092cb8c38cf6de4b8aeece45385c365c5ab7a3a7d3db6b1b57e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac Catheterization - instrumentation</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Catheter Ablation</topic><topic>Catheters</topic><topic>Electrocardiography</topic><topic>Electrodes</topic><topic>Electrophysiologic Techniques, Cardiac - instrumentation</topic><topic>Electrophysiologic Techniques, Cardiac - methods</topic><topic>Equipment Design</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Atria - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Studies</topic><topic>Tachycardia - physiopathology</topic><topic>Tachycardia - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sanders, Prashanthan</creatorcontrib><creatorcontrib>Hocini, Mélèze</creatorcontrib><creatorcontrib>Jaïs, Pierre</creatorcontrib><creatorcontrib>Hsu, Li-Fern</creatorcontrib><creatorcontrib>Takahashi, Yoshihide</creatorcontrib><creatorcontrib>Rotter, Martin</creatorcontrib><creatorcontrib>Scavée, Christophe</creatorcontrib><creatorcontrib>Pasquié, Jean-Luc</creatorcontrib><creatorcontrib>Sacher, Fréderic</creatorcontrib><creatorcontrib>Rostock, Thomas</creatorcontrib><creatorcontrib>Nalliah, Chrishan J.</creatorcontrib><creatorcontrib>Clémenty, Jacques</creatorcontrib><creatorcontrib>Haïssaguerre, Michel</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sanders, Prashanthan</au><au>Hocini, Mélèze</au><au>Jaïs, Pierre</au><au>Hsu, Li-Fern</au><au>Takahashi, Yoshihide</au><au>Rotter, Martin</au><au>Scavée, Christophe</au><au>Pasquié, Jean-Luc</au><au>Sacher, Fréderic</au><au>Rostock, Thomas</au><au>Nalliah, Chrishan J.</au><au>Clémenty, Jacques</au><au>Haïssaguerre, Michel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterization of Focal Atrial Tachycardia Using High-Density Mapping</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2005-12-06</date><risdate>2005</risdate><volume>46</volume><issue>11</issue><spage>2088</spage><epage>2099</epage><pages>2088-2099</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Characterization of Focal Atrial Tachycardia Using High-Density Mapping
Prashanthan Sanders, Mélèze Hocini, Pierre Jaïs, Li-Fern Hsu, Yoshihide Takahashi, Martin Rotter, Christophe Scavée, Jean-Luc Pasquié, Fréderic Sacher, Thomas Rostock, Chrishan J. Nalliah, Jacques Cleménty, Michel Haïssaguerre
Focal atrial tachycardias are characterized by atrial activity that originates from a small area (focus) and spreads out centrifugally. Mapping to identify these focal arrhythmias can be difficult. In this study, the role of high-density localized mapping to identify and characterize the origin of focal atrial tachycardia is evaluated. High-density localized mapping enables rapid vector mapping to identify the site of earliest activation. Localized mapping at the origin of some of these apparently “focal” atrial tachycardias demonstrated localized re-entry.
The goal of this study was to characterize the origin of focal atrial tachycardias (AT).
Focal ATs originate from a small area and spread centrifugally; however, activation at the AT origin has not been characterized.
Twenty patients with AT having failed prior ablation or occurring after atrial fibrillation ablation were studied. After excluding macro–re-entry, AT was mapped using a 20-pole catheter (five radiating spines; diameter 3.5 cm), performing vector mapping to identify the earliest activity followed by high-density mapping at the AT origin. Localized re-entry was considered if >85% of the tachycardia cycle length (CL) was observed within the mapping field and was confirmed by entrainment.
A total of 27 ATs were mapped to the pulmonary vein ostia (n = 5), and left (n = 16) and right atria (n = 6). A localized focus was evidenced at the site of origin in 19 ATs (70%), whereas in 8 (30%), localized re-entry was evidenced by 95.2 ± 4.5% of the tachycardia CL recorded within the mapping field and entrainment showed a post-pacing interval <20 ms longer than tachycardia CL (6 of 6 tested). Localized re-entry had a shorter CL (p = 0.009), slowed conduction at its origin (fractionated potential 115 ± 19 ms vs. 64 ± 22 ms, representing 49 ± 10% and 20 ± 10% of tachycardia CL, respectively; p < 0.0001), and were more often contiguous with regions of electrical silence or conduction abnormalities (88% vs. 32%; p = 0.01). In addition, mapping documented varying degrees of intra-atrial conduction block, preferential conduction (n = 5), and rapid bursts of myocardial activity (n = 1). At 11 ± 7 months, none have had recurrence of AT.
High-density multielectrode mapping can be used to perform vector mapping to localize complex AT. It provides novel insight into the mechanisms of focal AT, distinguishing focal AT from localized re-entry.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16325047</pmid><doi>10.1016/j.jacc.2005.08.044</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Biological and medical sciences Cardiac arrhythmia Cardiac Catheterization - instrumentation Cardiac dysrhythmias Cardiology Cardiology. Vascular system Catheter Ablation Catheters Electrocardiography Electrodes Electrophysiologic Techniques, Cardiac - instrumentation Electrophysiologic Techniques, Cardiac - methods Equipment Design Female Heart Heart Atria - physiopathology Humans Male Medical sciences Middle Aged Studies Tachycardia - physiopathology Tachycardia - surgery |
| title | Characterization of Focal Atrial Tachycardia Using High-Density Mapping |
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