A J Carton Sanchez

Hospital Universitario La Paz

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Marcel Martínez Cossiani

Hospital Universitario La Paz

José Luís Merino

Universidad Autónoma de Madrid

Dolores Merino

Hospital Juan Ramón Jiménez

María Eugenia Martínez Maldonado

Hospital Universitario La Paz

Jatin Relan

Abbott (United States)

Raquel Echavarría

Mexican Social Security Institute

Jay M. Mayatra

University College Dublin

Miguel Jáuregui Abularach

Hospital Universitario La Paz

Stephanie Y. Rhee

University of Minnesota

J. Melendro

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Hospital Universitario La Paz

Maharaja Sayajirao University of Baroda

University of Minnesota

University of Minnesota Medical Center

Masonic Cancer Center

University of Alberta

Universidad Autónoma de Madrid

Istituti di Ricovero e Cura a Carattere Scientifico

Hospital La Paz Institute for Health Research

Consejo Superior de Investigaciones Científicas

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Elsevier eBooks (2023)

Ethan G. Aguilar Farah Asa’ad Kiandokht Bashiri Rasheedunnisa Begum Marcel W. Bekkenk

10.1016/b978-0-323-85389-7.09987-7

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Localization of critical isthmus in left atrial macroreentrant tachycardias: insights from peak frequency mapping during sinus rhythm and coronary sinus pacing

EP Europace (2024)

A Handayani Takanori Yamaguchi S Kim Marcel Martínez Cossiani Jatin Relan

Abstract Background Successful ablation of left atrium macroreentrant tachycardia (LAMRT) has advanced significantly, benefiting from an enhanced understanding of reentrant mechanisms and technological innovations. However, challenges like difficult inductions and the presence of multiple coexistent LAMRTs can complicate tachycardia mapping, potentially resulting in recurrences during follow-up. Consequently, there is a growing need for strategies that focus on pinpointing the critical isthmus of conduction (CIC) in LAMRT circuits outside of tachycardia episodes. Peak frequency (PF) mapping, with its ability to discern near-field (NF) from far-field (FF) electrograms (EGMs) in low voltage areas, emerges as a valuable tool for precisely identifying these critical isthmuses. Purpose This study aims to investigate whether the accurate identification of the CIC in LAMRT circuits is achievable through PF mapping during sinus rhythm or coronary sinus pacing. Methods Patients with sustained LAMRT undergoing radiofrequency (RF) ablation were enrolled. Utilizing a 16-pole grid catheter (HD-Grid), bipolar voltage and activation maps were generated during LAMRT. PF maps were retrospectively computed. Voltage, activation, and PF maps were also created during sinus rhythm and coronary sinus pacing (500 ms). Potential CICs (P-CICs) were defined as areas with low voltage (<0.2 mV) and high PF (>250 Hz), covering a surface area of <2 cm2 by adjusting the PF threshold above 250 Hz. Only instances of LAMRT terminated by focal RF lesions (boundary <1.5 cm diameter) were included. Confirmed CICs (C-CICs) were identified at sites where LAMRT termination occurred due to RF application. The localization of P-CICs found during LAMRT, sinus rhythm (SR), and coronary sinus pacing (CSP) mapping, in relation to that of CIC, was analyzed, considering them matching if separated by <10 mm. Results Twenty-four consecutive patients with 26 atrial tachycardias (ATs) were prospectively enrolled, including 18 LAMRTs (270±63 ms) terminated by 2.2±2.9 focal RF lesions after 9.4±8.2 sec of energy delivery. A P-CIC was consistently identified at the tachycardia termination site during LAMRT mapping, with a visual cutoffs discrimination score (1-5) of 4.1±0.7, a mean P-P voltage cutoff <0.22±0.09 mV, and a mean PF cutoff >330±67 Hz in all patients. Importantly, P-CICs found during SR and CSP mapping matched those found during LAMRT mapping in all patients (figure). Conclusion PF mapping demonstrates precision in identifying the critical isthmus in LAMRT circuits during actual tachycardia episodes. Notably, the consistent identification of the CIC through PF mapping during sinus rhythm or coronary sinus pacing exhibits a high correlation with findings during LAMRT mapping. This approach holds promising potential for reducing arrhythmia recurrences, especially in scenarios involving multiple or unmappable LAMRTs.

Atrial tachycardia

Normal Sinus Rhythm

Sinus (botany)

10.1093/europace/euae102.825

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Doñana. Acta vertebrata. vol 6(1)

Luis Felipe López‐Jurado Lidia Dos-Santos Carmen Díaz‐Paniagua José A. Torres-Esquivias Amparo León

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Are reentrant atrial tachycardias sensitive to adenosine administration?

EP Europace (2023)

L E Guido Lopez Marcel Martínez Cossiani Dolores Merino María Eugenia Martínez Maldonado Sergio Castrejón Castrejón

Abstract Funding Acknowledgements Type of funding sources: None. Background Adenosine (ADN) infusion may terminate focal atrial tachycardia (AT). However, the effect of ADN on reentrant atrial tachycardia (RAT) is unclear and based on case reports and small series. These latter included mostly patients with cavotricuspid isthmus-dependent atrial flutter and provided conflicting results, with RAT termination found when it involved the septal or the tricuspid/mitral valve regions. Purpose The aim of this study was to test the response (termination, transient suppression or no effect) to ADN infusion on RATs and to evaluate differences according to the AT location. Methods The effect of ADN was prospectively studied at the time of catheter ablation in consecutive patients with AT. Only patients with RAT were included. This latter mechanism was established by activation and entrainment mapping and confirmed by catheter ablation. A 10 mg adenosine 5'-triphosphate (ATP) bolus was administered in all to evaluate the effects on AT cycle length and termination. Additional ATP bolus of 20 or 30 mg was administered if no AV block for at least 2 secs was obtained with the former ones. Results 58 patients (67, ±13 years old; 11 female) with 79 RAT were included. 38 RATs were right sided (34 cavotricuspid isthmus-depend atrial flutters, 1 lateral right atrium reentry, 1 upper loop reentry, 1 superior vena cava reentry, and 1 septal reentry around the coronary sinus) and 41 were left sided (21 perimitral reentry, 16 peripulmonary vein reentry and 4 with a small free wall reentry). No RAT was terminated or had a >20 ms cycle length prolongation following ADN administration. There was no transformation of the RAT into other mechanisms of AT or atrial fibrillation by ADN in any case. There were no complications. Conclusion RATs are insensitive to ADN infusion, with neither termination nor cycle length prolongation.

Reentry

Atrial tachycardia

Bolus (digestion)

10.1093/europace/euad122.233

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Doñana. Acta vertebrata. vol 3(1)

Enrique Collado J. Calderón Matilde Pérez F. Hiraldo B. Arroyo

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