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High-density characterization of the sinus rhythm: a new functional substrate map of scar-related atrial tachycardia

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Abstract

Background

Reentrant atrial tachycardias (ATs) utilize critical isthmus (CI) for the maintenance of the circuit. The electrophysiological characteristics and clinical implications of the targeted CI regions of reentrant ATs during sinus rhythm (SR) were not clear. Therefore, our research aims at studying the electrical properties of the CI sites for scar-related reentrant ATs and the functional substrate mapping identified during SR.

Methods

Patients mapped with high-density catheters during SR and reentrant ATs were retrospectively analyzed. The CI regions of the reentrant ATs were confirmed by the combination of the activation map and the entrainment. The substrate mapping was analyzed for wavefront propagation, conduction velocity, and electrogram patterns.

Results

Twenty patients with 22 reentrant ATs that underwent high-density maps were analyzed at 2 hospitals. Mapping performed during SR identified a scar region of 23.0 ± 13.6% of the left atrium. Regions of the CI in SR were characterized by low voltage (0.3 ± 0.2 mV), conduction slowing (0.4 ± 0.2 m/s), and fractionated electrogram (duration 62.5 ± 13.9 ms). Substrate mapping during SR showed that the regions of the CI located with the low-voltage zone in 16 out of 22 CI (72.7%), the deceleration zone in 15 out of 22 CI (68.2%), and late atrial activation in 12 out of 22 CI (54.5%). Targeting regions of CI achieve 94% of termination or change of the reentrant circuit. At 6.2 ± 7.1 months, there was 75% freedom from atrial arrhythmia.

Conclusions

Novel high-density mapping can identify the functional substrates during SR and guide ablation. Low-voltage areas with conduction slowing are putative predictors of the CI for the maintenance of the reentrant ATs.

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Data availability

Data are available on reasonable request to the corresponding author.

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Authors and Affiliations

  1. Department of Cardiology, Cardiovascular Research Center, Buddhist Tzu Chi General Hospital and Tzu Chi University, No. 707, Section 3, Zhongyang Road, Hualien City, Taiwan

    Wen-Chin Tsai

  2. Medicine and Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan

    Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Tze-Fan Chao, Fa-Po Chung, Jo-Nan Liao, Ting-Yung Chang, Ta-Chuan Tuan, Ling Kuo, Cheng-I Wu, Chih-Min Liu, Shin-Huei Liu, Ming-Ren Kuo & Shih-Ann Chen

  3. Heart Rhythm Center, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan

    Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Tze-Fan Chao, Fa-Po Chung, Jo-Nan Liao, Ting-Yung Chang, Ta-Chuan Tuan, Ling Kuo, Cheng-I Wu, Chih-Min Liu, Shin-Huei Liu, Ming-Ren Kuo & Shih-Ann Chen

  4. Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan

    Shih-Ann Chen

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  1. Wen-Chin Tsai
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Contributions

Wen-Chin Tsai: concept, data analysis and collection, drafting the article; Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Tze-Fan Chao, Fa-Po Chung, Jo-Nan Liao, Ting-Yung Chang, Ta-Chuan Tuan, Ling Kuo, Cheng-I Wu, Chih-Min Liu, Shin-Huei Liu, Ming-Ren Kuo, MD: concept/design, clinical data collection and approval of the article; Yenn-Jiang Lin and Shih-Ann Chen: critical revision of the article, approval of the article.

Corresponding authors

Correspondence to Wen-Chin Tsai or Yenn-Jiang Lin.

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Written informed consent was obtained from all patients and the study was approved by the institutional research committee.

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Tsai, WC., Lin, YJ., Chang, SL. et al. High-density characterization of the sinus rhythm: a new functional substrate map of scar-related atrial tachycardia. J Interv Card Electrophysiol 66, 1631–1639 (2023). https://doi.org/10.1007/s10840-023-01480-5

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  • DOI: https://doi.org/10.1007/s10840-023-01480-5

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