Catheter ablation of incisional atrial tachycardia using a novel mapping system: LocaLisa.

Abstract

Incisional atrial tachycardia occurs due to reentry around surgical scars. Pharmacological therapy is often ineffective. This study assessed the efficacy of a novel mapping system (LocaLisa) in facilitating catheter ablation of incisional atrial tachycardia circuits. Eight consecutive patients (four men, four women) with incisional atrial tachycardia (median age 23.5 years, range 9-44) following previous repair of congenital heart defects underwent transcatheter mapping and ablation of the arrhythmogenic substrate using a mapping system (LocaLisa) that allows localization of endocardial electrodes in a three-dimensional space. Critical isthmuses for the tachycardia circuits were identified by demonstrating concealed entrainment using standard pacing and mapping techniques. Scars and natural anatomic barriers were marked on the LocaLisa image. Lines of block were created by radiofrequency current application between scars and natural anatomic barriers, or between two scars, to close isthmuses demonstrated to be critical for the reentrant circuit. All lines of block were verified in both directions. All reentrant circuits around incisions were successfully ablated. Seven additional tachycardia mechanisms were identified in four patients (common atrial flutter [n = 4], atrioventricular nodal [AVN] reentry [n = 2], ectopic atrial tachycardia [n = 1]) and were also ablated in a single session. The mean fluoroscopy time was 28.4 +/- 13.8 minutes. All patients are arrhythmia-free at a median follow-up of 20 (6-22) months. The LocaLisa mapping system is effective for identification of scars and ablation targets, for confirming lines of block, and facilitating ablation of complex reentrant circuits.