Entrainment mapping for rapid distinction of left and right atrial tachycardias

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Hidekazu MiyazakiLaurence M Epstein

Abstract

Distinguishing left from right atrial tachycardia is a critical step for guiding ablation. The purpose of this study was to develop and validate a simple algorithm predicting the location of macroreentrant atrial tachycardia (AT) circuits from limited entrainment mapping in right atrium (RA) and coronary sinus (CS). In 180 patients with organized reentrant AT, entrainment was performed at the high RA, proximal CS, and distal CS. The difference between the postpacing interval (PPI) and tachycardia cycle length (TCL) was calculated at each site. The location of the AT reentrant circuit was determined by mapping and ablation. An algorithm predicting AT regions was developed from 104 ATs in the first 90 patients (group I) and prospectively evaluated in a validation cohort of 106 ATs in the second 90 patients (group II). In group I, PPI-TCL difference <50 or >50 ms at the high RA distinguished RA from LA reentrant circuits. For RA tachycardias, PPI-TCL difference at the proximal CS distinguished common flutter from lateral RA circuits. For LA circuits, PPI-TCL difference at the proximal and distal CS distinguished perimitral reentry from reentry involving the right pulmonary veins and septum. In group II, an algorithm based on PPI-T...Continue Reading

References

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Citations

Feb 23, 2013·Journal of Clinical Monitoring and Computing·Piotr Podziemski, Jan J Zebrowski
Mar 30, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Kyoko Soejima
Mar 9, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Shih-Lin Chang, Shih-Ann Chen
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Nov 26, 2010·Pacing and Clinical Electrophysiology : PACE·Weizhu JuMinglong Chen
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May 2, 2006·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Isabel Deisenhofer
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