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Outcomes of catheter ablation of atrial tachyarrhythmia guided exclusively by activation mapping

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Abstract

Introduction

Complex atrial tachyarrhythmias (CATs) are commonly observed in patients with prior catheter ablation or cardiac surgery. These arrhythmias are challenging to map and ablate. Historically, entrainment mapping was utilized to characterize CAT. With the advent of high-definition mapping (HDM), full visualization of the CAT circuit is possible which may obviate the need for entrainment mapping.

Methods

We sought to investigate the outcomes of catheter ablation of CAT guided only by HDM. Consecutive patients who underwent CAT ablation from 2017 to 2021 were included in our study (excluding right atrial tachyarrhythmias). Patients were sorted by the type of mapping performed. Group I consisted of patients where HDM alone was utilized with no attempt of entrainment. Group II consisted of patients where both entrainment and HDM were utilized.

Results

A total of 67 patients were included in our study, with 40 patients in HDM group (I) and 27 patients in entrainment group (II). No statistically significant difference regarding 1-year freedom from atrial arrhythmias was found between the two groups (80% vs 77.8%, p = 0.819). Four CATs were terminated by entrainment during procedure versus none in the HDM-only group (p = 0.011).

Conclusions

CAT ablation with HDM alone yielded similar 1-year freedom from atrial arrhythmias compared to ablation with HDM and entrainment. Entrainment combined with HDM was associated with higher undesired CAT interruption rate. Further validation is needed with randomized control trials.

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Authors and Affiliations

  1. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Xiaodong Zhang, Aung Lin, Fengwei Zou, Jacopo Marazzato, Emma Levine & Luigi Di Biase

  2. New York City Health + Hospitals/Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Weijia Li, Dimitrios Varrias, Sanjana Nagraj, Yu-Chiang Wang & Jiyoung Seo

  3. Department of Medicine and Surgery, University of Insubria, Varese, Italy

    Jacopo Marazzato

  4. Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

    Domenico G. Della Rocca, Andrea Natale & Luigi Di Biase

  5. Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Pasquale Santangeli

  6. Kansas City Heart Rhythm Institute, HCA Midwest Health, Kansas City, MO, USA

    Dhanunjaya Lakkireddy

Authors
  1. Xiaodong Zhang
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  10. Domenico G. Della Rocca
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  13. Dhanunjaya Lakkireddy
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  14. Andrea Natale
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  15. Luigi Di Biase
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Corresponding author

Correspondence to Luigi Di Biase.

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Conflict of interest

Dr. Di Biase is a consultant for Stereotaxis, Biosense Webster, Boston Scientific, and Abbott Medical and has received speaker honoraria/travel from Medtronic, Atricure, Biotronik, Baylis Medical, and Zoll. Dr. Pasquale Santangeli is a consultant for Biosense Webster, Abbott, Baylis Medical, InHeart, and Farapulse. Dr. Natale is a consultant for Biosense Webster, Stereotaxis, and Abbott and has received speaker honoraria/travel from Medtronic, Atricure, Biotronik, and Janssen. The remaining authors report no conflict of interest.

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What is new?

• This is the first study comparing HDM alone and combined entrainment mapping in patients undergoing CAT ablation.

• CAT ablation with HDM alone yielded similar 1-year freedom from atrial arrhythmias compared to ablation with both HDM and entrainment.

• Entrainment combined with HDM was associated with higher undesired CAT interruption rate.

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Zhang, X., Li, W., Lin, A. et al. Outcomes of catheter ablation of atrial tachyarrhythmia guided exclusively by activation mapping. J Interv Card Electrophysiol 66, 1383–1389 (2023). https://doi.org/10.1007/s10840-022-01435-2

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  • DOI: https://doi.org/10.1007/s10840-022-01435-2

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