Abstract
Although the mechanism of an AT can usually be elucidated using modern high-resolution mapping systems, it would be helpful if the AT mechanism and circuit could be predicted before initiating mapping. We examined if information gathered from the cycle length (CL) of the tachycardia can help predict AT-mechanism and its localization. 138 activation maps of ATs including 8 focal-ATs, 94 macroreentrant-ATs and 36 localized-ATs in 95 patients were retrospectively reviewed. Maximal CL (MCL) and minimal CL (mCL) over a minute period were measured via a decapolar catheter in the coronary sinus. CL-variation and beat-by-beat CL-alternation were examined. Additionally, CL-respiration correlation was analyzed by the RhythmiaTM system. Both MCL and mCL were significantly shorter in macroreentrant-ATs (MCL = 288[253-348]ms, p = 0.0001; mCL = 283[243-341]ms, p = 0.0012), and also shorter in localized-ATs (MCL = 314[261-349]ms, p = 0.0016; mCL = 295[248-340]ms, p = 0.0047) compared to focal-ATs (MCL = 506[421-555]ms, mCL = 427[347-508]ms). An absolute CL-variation (MCL-mCL) < 24 ms significantly differentiated reentrant ATs from focal-ATs with a sensitivity = 96.9%, specificity = 100%, positive predictive value (PPV) = 100% and negative predictive value (NPV) = 66.7%. The beat-by-beat CL-alternation was observed in 10/138 (7.2%), all of which showed the reentrant mechanism, meaning that beat-by-beat CL-alternation was the strong sign of reentrant mechanism (PPV = 100%). Although the CL-respiration correlation was observed in 28/138 (20.3%) of ATs, this was predominantly in right-atrium (RA)-ATs (24/41, 85.7%), rather than left atrium (LA)-ATs (4/97, 4.1%). A positive CL-respiration correlation highly predicted RA-ATs (PPV = 85.7%), and negative CL-respiration correlation probably suggested LA-ATs (NPV = 84.5%). Detailed analysis of the tachycardia CL helps predict the AT-mechanism and the active AT chamber before an initial mapping.
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Schedule a callMore From: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
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