Detailed analysis of tachycardia cycle length aids diagnosis of the mechanism and location of atrial tachycardias

AIMS: Although the mechanism of an atrial tachycardia (AT) can usually be elucidated using modern high-resolution mapping systems, it would be helpful if the AT mechanism and circuit could be predicted before initiating mapping. OBJECTIVE: We examined if the information gathered from the cycle lengt...

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Detalles Bibliográficos
Autores principales: Takigawa, Masateru, Kamakura, Tsukasa, Martin, Claire, Derval, Nicolas, Cheniti, Ghassen, Duchateau, Josselin, Pambrun, Thomas, Sacher, Frederic, Cochet, Hubert, Hocini, Meleze, Negishi, Miho, Yamamoto, Tasuku, Ikenouchi, Takashi, Goto, Kentaro, Shigeta, Takatoshi, Nishimura, Takuro, Tao, Susumu, Miyazaki, Shinsuke, Goya, Masahiko, Sasano, Tetsuo, Haissaguierre, Michel, Jais, Pierre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Clinical Research
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403248/
https://www.ncbi.nlm.nih.gov/pubmed/37428890
http://dx.doi.org/10.1093/europace/euad195
Descripción
Sumario:AIMS: Although the mechanism of an atrial tachycardia (AT) can usually be elucidated using modern high-resolution mapping systems, it would be helpful if the AT mechanism and circuit could be predicted before initiating mapping. OBJECTIVE: We examined if the information gathered from the cycle length (CL) of the tachycardia can help predict the AT-mechanism and its localization. METHODS: One hundred and thirty-eight activation maps of ATs including eight focal-ATs, 94 macroreentrant-ATs, and 36 localized-ATs in 95 patients were retrospectively reviewed. Maximal CL (MCL) and minimal CL (mCL) over a minute period were measured via a decapolar catheter in the coronary sinus. CL-variation and beat-by-beat CL-alternation were examined. Additionally, the CL-respiration correlation was analysed by the Rhythmia(TM) system. : Both MCL and mCL were significantly shorter in macroreentrant-ATs [MCL = 288 (253–348) ms, P = 0.0001; mCL = 283 (243–341) ms, P = 0.0012], and also shorter in localized-ATs [MCL = 314 (261–349) ms, P = 0.0016; mCL = 295 (248–340) ms, P = 0.0047] compared to focal-ATs [MCL = 506 (421–555) ms, mCL = 427 (347–508) ms]. An absolute CL-variation (MCL-mCL) < 24 ms significantly differentiated re-entrant ATs from focal-ATs with a sensitivity = 96.9%, specificity = 100%, positive predictive value (PPV) = 100%, and negative predictive value (NPV) = 66.7%. The beat-by-beat CL-alternation was observed in 10/138 (7.2%), all of which showed the re-entrant mechanism, meaning that beat-by-beat CL-alternation was the strong sign of re-entrant mechanism (PPV = 100%). Although the CL-respiration correlation was observed in 28/138 (20.3%) of ATs, this was predominantly in right-atrium (RA)-ATs (24/41, 85.7%), rather than left atrium (LA)-ATs (4/97, 4.1%). A positive CL-respiration correlation highly predicted RA-ATs (PPV = 85.7%), and negative CL-respiration correlation probably suggested LA-ATs (NPV = 84.5%). CONCLUSION: Detailed analysis of the tachycardia CL helps predict the AT-mechanism and the active AT chamber before an initial mapping.

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