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Resetting of atrial tachycardia by a scanned extrastimulus at a downstream site on a multielectrode catheter: a simple diagnostic maneuver for locating the macroreentrant atrial tachycardia circuit

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Abstract

Purpose

Entrainment is a useful method for locating reentrant atrial tachycardia (AT) circuits, but alterations or termination of the AT can derail this process. We assessed whether resetting an upstream site of a neighboring electrode by a scanned extrastimulus at a downstream site (when the upstream tissue was refractory) could diagnose that site within the AT circuit.

Methods

The procedure was applied to 48 ATs with a cycle length (CL) of 238 ± 42 ms (26 common flutters, 8 perimitral flutters, 7 left atrial [LA] roof-dependent AT, 3 LA scar-related macroreentrant ATs, 2 pulmonary vein-gap reentry tachycardias, 1 right atrial scar-related macroreentrant AT, and 1 with an unidentified circuit). Entrainment and scanned extrastimulation were attempted at the cavotricuspid isthmus, LA roof, and mitral isthmus and/or critical AT isthmus.

Results

Within the circuit, the post-pacing interval minus the ATCL after entrainment was < 30 ms for all ATs and resetting of the AT cycle by ≥ 5 ms occurred in 94% of the ATs. No ATs were reset by extrastimulation outside the circuit. The positive predictive value of both maneuvers for locating the circuit was 100%, and the negative predictive value of the extrastimulation was similar to that of entrainment (96% vs. 100%, P = 0.25). The incidence of an AT alteration was lower with extrastimulation than with entrainment (1% vs. 9%, P = 0.01). For ATs with a CL < 210 ms, extrastimulation yielded a good diagnostic performance without any AT alterations.

Conclusion

AT resetting by a scanned extrastimulus is diagnostic and avoids AT alterations.

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Abbreviations

AT:

Atrial tachycardia

AF:

Atrial fibrillation

PVI:

Pulmonary vein isolation

LA:

Left atrium

CL:

Cycle length

CS:

Coronary sinus

CTI:

Cavotricuspid isthmus

MI:

Mitral isthmus

PCL:

Pacing cycle length

TAd:

Time advancement of downstream

TAu:

Time advancement of upstream

TCL:

Tachycardia cycle length

PPI:

Post-pacing interval

RF:

Radiofrequency

PPV:

Positive predictive value

NPV:

Negative predictive value

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Acknowledgment

We thank Mr. John Martin for his help in the preparation of the manuscript.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Yuji Wakamatsu, Koichi Nagashima, Kazuki Iso, Ryuta Watanabe, Masaru Arai, Naoto Otsuka, Satoshi Hayashida, Seina Yagyu, Syu Hirata, Sayaka Kurokawa, Ohkubo Kimie, Toshiko Nakai & Yasuo Okumura

  2. Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku, Kawaguchi-shi, Saitama, 333-0833, Japan

    Kazuki Iso & Satoshi Hayashida

  3. Tokyo Rinkai Hospital, 1-4-2 Rinkaicho, Edogawa-ku, Tokyo, 134-0086, Japan

    Kazumasa Sonoda

Authors
  1. Yuji Wakamatsu
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  2. Koichi Nagashima
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  3. Kazuki Iso
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  4. Kazumasa Sonoda
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  14. Yasuo Okumura
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Corresponding author

Correspondence to Koichi Nagashima.

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The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the local ethics board and complies with the Declaration of Helsinki.

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The data that support the findings of this study are available from the corresponding author on reasonable request.

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Wakamatsu, Y., Nagashima, K., Iso, K. et al. Resetting of atrial tachycardia by a scanned extrastimulus at a downstream site on a multielectrode catheter: a simple diagnostic maneuver for locating the macroreentrant atrial tachycardia circuit. J Interv Card Electrophysiol 63, 39–47 (2022). https://doi.org/10.1007/s10840-020-00934-4

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  • DOI: https://doi.org/10.1007/s10840-020-00934-4

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