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Intuitive diagnosis of complex atrial tachycardia mechanisms using a novel histogram module of an ultra-high-resolution mapping system

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Abstract

Purpose

The LUMIPOINT™ software module was developed to aid the physician in determining the mechanism of individual atrial tachycardias (ATs). The purpose of this study was to assess the clinical utility of the SKYLINE™ histogram that is a part of LUMIPOINT™.

Methods

This study included consecutive patients with iatrogenic sustained AT who underwent catheter ablation using conventional mapping (RHYTHMIA™). SKYLINE™ patterns were analyzed offline and classified into two types: (1) focal type (type-F) exhibiting a low-amplitude (relative activating surface area < 10%) plateau period and (2) reentrant type (type-R) showing no plateau period. How well the two patterns distinguished between focal and macroreentrant ATs as determined by conventional mapping was evaluated.

Results

We studied 101 iatrogenic ATs in 91 patients (female: 24, mean age: 67.3 ± 9.1 years). Activation mapping revealed 79 (78.2%) macroreentrant, 6 (5.9%) localized reentrant, and 16 (15.8%) focal ATs. Among the 72 type-R ATs, the mechanism was truly a macroreentry in 70 ATs. However, one focal AT and one localized reentrant AT displayed a type-R pattern (pseudo-reentry pattern). In the 29 type-F ATs, nine macroreentrant ATs were recognized (pseudo-focal pattern). Using SKYLINE™ type-R to differentiate macroreentrant AT from AT with centrifugal activation (focal or localized reentry), the sensitivity and specificity were 88.6% and 90.9%, respectively. Even when the SKYLINE™ type did not match the mapping-based AT mechanism, all discrepancies were electrophysiologically explicable using the SKYLINE™ histograms.

Conclusions

SKYLINE™ histograms are a useful tool for the intuitive diagnosis of AT mechanisms.

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References

  1. Wasmer K, Mönnig G, Bittner A, et al. Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation. Heart Rhythm. 2012;9:1660–6.

    Article  Google Scholar 

  2. Rostock T, Drewitz I, Steven D, et al. Characterization, mapping, and catheter ablation of recurrent atrial tachycardias after stepwise ablation of long-lasting persistent atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:160–9.

    Article  Google Scholar 

  3. Gerstenfeld EP, Callans DJ, Sauer W, Jacobson J, Marchlinski FE. Reentrant and nonreentrant focal left atrial tachycardias occur after pulmonary vein isolation. Heart Rhythm. 2005;2:1195–202.

    Article  Google Scholar 

  4. Nakagawa H, Ikeda A, Sharma T, et al. Rapid high resolution electroanatomic mapping: evaluation of a new system in a canine atrial linear lesion model. Circ Arrhythm Electrophysiol. 2012;5:417–24.

    Article  Google Scholar 

  5. Tanaka Y, Genet M, Chuan Lee L, et al. Utility of high-resolution electroanatomic mapping of the left ventricle using a multispline basket catheter in a swine model of chronic myocardial infarction. Heart Rhythm. 2015;12:144–54.

    Article  Google Scholar 

  6. Martin CA, Takigawa M, Martin R, et al. Use of novel electrogram “Lumipoint” algorithm to detect critical isthmus and abnormal potentials for ablation in ventricular tachycardia. JACC Clin Electrophysiol. 2019;5:470–9.

    Article  Google Scholar 

  7. Saoudi N, Cosio F, Waldo A, et al. Classification of atrial flutter and regular atrial tachycardia according to electrophysiologic mechanism and anatomic bases: a statement from a joint expert group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. J Cardiovasc Electrophysiol. 2001;12:852–66.

    Article  CAS  Google Scholar 

  8. Luther V, Sikkel M, Bennett N, et al. Visualizing localized reentry with ultra-high density mapping in iatrogenic atrial tachycardia: beware pseudo-reentry. Circ Arrhythm Electrophysiol. 2017;10:e004724.

    Article  Google Scholar 

  9. Takigawa M, Martin CA, Derval N, et al. Insights from atrial surface activation throughout atrial tachycardia cycle length: a new mapping tool. Heart Rhythm. 2019;16:1652–60.

    Article  Google Scholar 

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Authors and Affiliations

Authors

Contributions

Y. Tanaka, the corresponding author, contributed to the conception and design of this study, examination, data analysis, and drafting. A. Takahashi and K. Okubo contributed to the data analysis and revised the manuscript for important intellectual content. N. Kawaguchi, E. Nakashima, J. Nakajima, K. Takagi, and H. Hikita contributed to the examination and data analysis. T. Sasano contributed to discussion and interpretation of the data, final approval of the manuscript submitted.

Corresponding author

Correspondence to Yasuaki Tanaka.

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The authors declare no competing interests.

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Tanaka, Y., Takahashi, A., Kawaguchi, N. et al. Intuitive diagnosis of complex atrial tachycardia mechanisms using a novel histogram module of an ultra-high-resolution mapping system. J Interv Card Electrophysiol 64, 203–215 (2022). https://doi.org/10.1007/s10840-022-01165-5

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  • DOI: https://doi.org/10.1007/s10840-022-01165-5

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