Ablation of scar-related reentrant atrial tachycardias with epi-to-endo bridging is less successful - 06/01/20
Résumé |
Background |
Epicardial portions of the circuit of endocardial re-entrant tachycardias are well established phenomena in the ventricles, but little is known about a similar phenomenon in post lesion atrial tachycardia (AT).
Objective |
Higher spatial and voltage mapping capabilities may help identify extra-endocardial bridging (EEB) during tachycardia.
Methods |
We retrospectively analysed our database of 119 pts with AT cases with ultra-high density mapping between March 2015 and March 2018. Epi-to-endo breakthrough sites were diagnosed when endocardial activation started at a discrete point before spreading radially in every available direction. PPI after transient entrainment at these sites confirmed local participation in AT.
Results |
In 20 out of the 119 pts (mean age 70±9 yrs, always with ≥1 prior procedures), 2 types of EEB were found. Type 1 is a “myocardial” EEB (n=16). Subtype 1A (Fig. 1) with a visible antidromic wavefront back to a line of block (n=10) whereas in subtype 1B activation starts immediately adjacent to a usually large line of block. Type 2 implied an extra-atrial “venous” bridging, either as a “shunt” over a line of block (subtype 2A, n=6) or by using an epicardial vein as a major part of a circuit (subtype 2B, n=1). In presence of EEB, AT termination was 17/22 (77%), significantly lower than our historical cohort of nonEEB AT (97%, P=0.03). The most successful strategy was targeting epi-endo breakthrough site.
Conclusion |
Atrial EEB using either epicardial layers of the atrial wall, or extra-atrial venous structures is confirmed. Successful ablation at epi-to-endo breakthrough site proves the validity of the concept but results of ablation are inferior to nonEEB AT.
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Vol 12 - N° 1
P. 114-115 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.