Identification of critical isthmus using coherent mapping in patients with scar-related atrial tachycardia

Jennifer Jeanne B. Vicera, Yenn Jiang Lin, Po Tseng Lee, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Fa Po Chung, Chin Yu Lin, Ting Yung Chang, Ta Chuan Tuan, Tze Fan Chao, Jo Nan Liao, Cheng I. Wu, Chih Min Liu, Chung Hsing Lin, Chieh Mao Chuang, Chun Chao Chen, Chye Gen Chin, Shin Huei Liu, Wen Han ChengLe Phat Tai, Sung Hao Huang, Ching Yao Chou, Isaiah Lugtu, Ching Han Liu, Shih Ann Chen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Accurate identification of slow conducting regions in patients with scar-related atrial tachycardia (AT) is difficult using conventional electrogram annotation for cardiac electroanatomic mapping (EAM). Estimating delays between neighboring mapping sites is a potential option for activation map computation. We describe our initial experience with CARTO 3 Coherent Mapping (Biosense Webster Inc,) in the ablation of complex ATs. Methods: Twenty patients (58 ± 10 y/o, 15 males) with complex ATs were included. We created three-dimensional EAMs using CARTO 3 system with CONFIDENSE and a high-resolution mapping catheter (Biosense Webster Inc). Local activation time and coherent maps were used to aid in the identification of conduction isthmus (CI) and focal origin sites. System-defined slow or nonconducting zones and CI, defined by concealed entrainment (postpacing interval < 20 ms), CV < 0.3 m/s and local fractionated electrograms were evaluated. Results: Twenty-six complex ATs were mapped (mean: 1.3 ± 0.7 maps/pt; 4 focal, 22 isthmus-dependent). Coherent mapping was better in identifying CI/breakout sites where ablation terminated the tachycardia (96.2% vs 69.2%; P =.010) and identified significantly more CI (mean/chamber 2.0 ± 1.1 vs 1.0 ± 0.7; P <.001) with narrower width (19.8 ± 10.5 vs 43.0 ± 23.9 mm; P <.001) than conventional mapping. Ablation at origin and CI sites was successful in 25 (96.2%) with long-term recurrence in 25%. Conclusions: Coherent mapping with conduction velocity vectors derived from adjacent mapping sites significantly improved the identification of CI sites in scar-related ATs with isthmus-dependent re-entry better than conventional mapping. It may be used in conjunction with conventional mapping strategies to facilitate recognition of slow conduction areas and critical sites that are important targets of ablation.

Original languageEnglish
Pages (from-to)1436-1447
Number of pages12
JournalJournal of Cardiovascular Electrophysiology
Volume31
Issue number6
DOIs
Publication statusPublished - Jun 1 2020

Keywords

  • activation mapping
  • atrial tachycardia
  • coherent mapping
  • focal atrial tachycardia
  • scar-related macro re-entrant

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Vicera, J. J. B., Lin, Y. J., Lee, P. T., Chang, S. L., Lo, L. W., Hu, Y. F., Chung, F. P., Lin, C. Y., Chang, T. Y., Tuan, T. C., Chao, T. F., Liao, J. N., Wu, C. I., Liu, C. M., Lin, C. H., Chuang, C. M., Chen, C. C., Chin, C. G., Liu, S. H., ... Chen, S. A. (2020). Identification of critical isthmus using coherent mapping in patients with scar-related atrial tachycardia. Journal of Cardiovascular Electrophysiology, 31(6), 1436-1447. https://doi.org/10.1111/jce.14457