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Comprehensive Multicenter Study of the Common Isthmus in Post-Atrial Fibrillation Ablation Multiple-Loop Atrial

Masateru Takigawa1,2, Nicolas Derval3, Philippe Maury4

  • 1Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, France (M.T., N.D., R.M., A.D., A.F., K.V., T.K., G.C., G.M., N.T., C.A.M., M.W., X.P., J.D., N.K., T.P., F.S., H.C., M. Hocini, M. Hai.ssaguerre, P.J.). teru.takigawa@gmail.com.

Circulation. Arrhythmia and Electrophysiology
|May 18, 2018
PubMed

Insights

Multiple-loop atrial tachycardias (ATs) are complex, often involving anatomic circuits. This study characterized these complex ATs, revealing distinct features based on the combination of anatomic macroreentrant ATs and non-anatomic circuits.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Multiple-loop atrial tachycardia (AT) circuit characteristics remain poorly understood.
  • Previous studies have not precisely examined the detailed features of these complex arrhythmias.

Purpose of the Study:

  • To precisely examine the characteristics of multiple-loop atrial tachycardia circuits.
  • To classify and analyze the distinct features of dual-loop and triple-loop ATs.

Main Methods:

  • High-resolution mapping system used to diagnose 44 multiple-loop ATs in 193 consecutive patients post-atrial fibrillation ablation.
  • Off-line analysis of diagnosed multiple-loop ATs, including dual-loop and triple-loop configurations.
  • Classification of dual-loop ATs into types M, MN, and N based on the combination of anatomic macroreentrant ATs (AMATs) and non-AMATs.

Main Results:

  • 44 multiple-loop ATs (42 dual-loop, 2 triple-loop) were identified in 41 patients (21.2%).
  • Dual-loop ATs were classified into Type M (2 AMATs), Type MN (1 AMAT, 1 non-AMAT), and Type N (2 non-AMATs).
  • Common isthmus dimensions (length, area, width) and electrogram characteristics (duration, voltage) significantly differed among Type M, MN, and N ATs, with Type N showing longer duration and lower voltage.

Conclusions:

  • Multiple-loop ATs are complex and frequently incorporate anatomic circuits.
  • These complex ATs exhibit specific characteristics determined by the interplay of AMATs and non-AMATs.
  • Understanding these distinct features is crucial for effective diagnosis and management of complex atrial tachycardias.
Abstract

Keywords:
atrial fibrillationcatheter ablationconscious sedationpulmonary veinstachycardia

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