Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias.

Autor:	Strisciuglio T; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy., Vandersickel N; Department of Physics and Astronomy, Ghent University, Ghent, Belgium., Lorenzo G; Biosense Webster Inc., Irvine, California., Van Nieuwenhuyse E; Department of Physics and Astronomy, Ghent University, Ghent, Belgium., El Haddad M; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium., De Pooter J; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium; Ghent University Hospital, Heart Center, Ghent, Belgium., Kyriakopoulou M; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium., Almorad A; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium., Lycke M; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium., Vandekerckhove Y; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium., Tavernier R; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium., Duytschaever M; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium; Ghent University Hospital, Heart Center, Ghent, Belgium., Knecht S; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium. Electronic address: sebastien.knecht@azsintjan.be.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2020 Feb; Vol. 17 (2), pp. 211-219. Date of Electronic Publication: 2019 Sep 14.
DOI:	10.1016/j.hrthm.2019.09.014
Abstrakt:	Background: Identification of atrial tachycardia (AT) mechanism remains challenging. Objective: We sought to investigate the added value of entrainment maneuvers (EM) when using new high-density activation mapping (HDAM) technologies for the identification of complex left ATs. Methods: Thirty-six consecutive complex ATs occurring after ablation of persistent atrial fibrillation were prospectively analyzed. The AT mechanism was diagnosed in 2 steps by 2 experts: (1) based on HDAM only (Coherent module, CARTO, Biosense Webster Inc., Irvine, CA) and (2) with additional analysis from EM. Results: EM resulted in atrial fibrillation in 1 patient, who was excluded from the analysis. Ten of 11 single loop macroreentries identified by HDAM were confirmed by EM. Only 4 of 14 double loop macroreentries identified by HDAM wereconfirmed by EM (in 10 patients, EM unmasked passive activation of one of the visual circuits). One sole microreentry circuit identified by HDAM was confirmed by EM. A combination of macro- and microreentry circuits was visualized in 3 ATs using HDAM. However, EM revealed passive activation of the visual macroreentrant loop in 2 of these 3 cases. By using HDAM in 6 of 35 ATs (17%), no univocal mechanism could be identified, whereas EM finally enabled the diagnosis of 5 microreentry circuits and 1 macroreentrant AT. All the diagnoses made from EM in addition to HDAM were confirmed by ablation. Conclusion: Entrainment maneuvers are still useful during mapping of complex left ATs, mostly to differentiate active from passive macroreentrant loops and to demonstrate microreentry circuits. (Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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