The Use of Local Activation Timing Histogram in Ablation of Focal and Re-Entrant Atrial Tachycardias

Abstract

BackgroundActivation mapping is often used to differentiate focal from re-entrant arrhythmias. This can be challenging but is critical to ablation success. The local activation time (LAT) histogram, which depicts point distribution over isochronal segments, may help characterize arrhythmia mechanisms and identify an optimal ablation strategy. ObjectivesThis study aimed to investigate features of the LAT histogram associated with the focal vs re-entrant mechanism of atrial tachycardias (ATs) and the use of the LAT histogram in the identification of target ablation sites. MethodsWe retrospectively evaluated cases of focal and re-entrant ATs performed at a single academic tertiary care center for which activation mapping was performed using CARTO 3 version 7 software (Biosense Webster). Baseline patient, arrhythmia, and procedural characteristics as well as LAT histogram features were evaluated for each case. LAT histogram–guided ablation targets were also compared against actual ablation sites. ResultsAmong 52 ATs assessed, 17 were focal, and 35 were re-entrant. Tachycardia cycle length was significantly shorter in re-entrant than in focal ATs (288.2 milliseconds [Q1-Q3: 250-306.5 milliseconds] vs 370 milliseconds [Q1-Q3: 285-400 milliseconds], respectively; P = 0.006). LAT histograms contained more “valleys” in re-entrant than in focal ATs (3 [Q1-Q3: 2-4] vs 1 [Q1-Q3: 1-1]; P < 0.001). No focal ATs contained >2 and no re-entrant ATs contained <1 LAT valley(s). All successful ablation sites correlated with LAT histogram–suggested sites. ConclusionsLAT histograms can help distinguish focal from re-entrant Ats and identify effective ablation sites.