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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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.
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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