Functional substrate mapping characteristics during sinus rhythm predicts critical isthmus of scar related atrial tachycardia

Abstract

Listen

Translate article

Abstract Background Atrial tachycardia (AT) is a common rhythm disorder in patients with underlying atrial scar due to previous atrial surgery or valvular heart disease. Data is scarce about the role of functional characteristics or conduction properties during sinus rhythm that may have role in the critical isthmus (CI) of re-entry. Purpose We aimed to evaluate the relationship between the functional substrate mapping (FSM) characteristics of right and left atrium and the CI of re-entrant ATs in patients with atrial low-voltage areas. Methods A total of 95 [mean age: 57 ± 13, gender: 57 (60%) female] symptomatic patients with history of left and right AT who underwent catheter ablation with 3-D high-density mapping were enrolled. Isochronal late activation mapping were created during sinus/paced rhythm to detect deceleration zones (DZ). After induction of AT, activation mapping was performed in all patients. Results In 95 patients, 96 left-ATs [49 (51%) ATs were macroreentry and 47 (49%) ATs were localized reentry] and 40 right-ATs [24 (60%) ATs were macroreentry and 16 (40%) ATs were localized reentry] were mapped. Atrial low voltage zones comprised 23.3 ± 13.0 % of total right atrium and 33.3 ± 21.2 % of total left atrium. The mean value of bipolar voltage, EGM duration, and conduction velocity during sinus rhythm corresponding to CI of ATs were 0.17 ± 0.10 mV, 121 ± 39 ms, and 0.09 ± 0.06 m/s, respectively. Total number of DZs were 125 and all CIs of reentry were colocalized with DZs detected during FSM. The positive predictive value of DZs to detect CI of inducible ATs is 87.2%. Freedom from ATa was 76.8% at 12 months follow-up. Conclusion Our findings demonstrated the utility of FSM during sinus rhythm to predict the successful termination sites for ATs. These areas displayed continuous-fragmented signal morphology in correlation with the CI of AT detected during activation mapping.