An improved window of interest for electroanatomical mapping of atrial tachycardia

• Published in: Journal of interventional cardiac electrophysiology Vol. 63; no. 1; pp. 29 - 37
• Main Authors: Mechulan, Alexis, Bun, Sok-Sithikun, Masse, Alexandre, Peret, Angélique, Leong-Feng, Lauriane, Pons, Frederic, Bouharaoua, Ahmed, Dieuzaide, Pierre, Prévot, Sébastien
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-01-2022; Springer Nature B.V
• Subjects: Ablation; Annotations; Arrhythmia; Cardiac arrhythmia; Cardiology; Catheter Ablation; Diagnosis; Elastic waves; Fibrosis; Heart Atria - surgery; Humans; Mapping; Medicine; Medicine & Public Health; Navigation systems; P waves; Tachycardia; Tachycardia, Supraventricular - diagnosis; Tachycardia, Supraventricular - surgery; Window of interest; Mitral isthmus; Atrial tachycardia; Electroanatomical mapping
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-021-00940-0

Purpose
Diagnosis of atrial tachycardia (AT) with 3D mapping system remains challenging due to fibrosis or previous ablation. This study aims to evaluate a new electroanatomical mapping annotation setting using a window of interest adjusted at the end of the P wave (WOI
p wave
) to identify the AT mechanism more accurately.
Methods
Twenty patients with successful ablation of left AT using navigation system CARTO3 were evaluated. Two maps for each patient were generated offline using either conventional settings of WOI (WOI
conv.
) or WOI
p wave
. Three investigators from two centres analysed the maps blindly.
Results
Mechanisms of AT were macroreentrant in 14/20 patients (70%) and focal in 6/20 (30%). WOI
p wave
resulted in a significant increase in the percentage of correct identification of the mechanism based on mapping alone (93.3 ± 13.7% vs 58.3 ± 33.9%;
p
 = 0.0003) compared with WOI
conv.
. Diagnoses based on mapping were arrived at faster (27.8 ± 16.4 s vs 38.97 ± 13.64 s, respectively;
p
 = 0.0231) and with a greater confidence in the diagnosis (confidence index 2.57 ± 0.45 vs 2.12 ± 0.45, respectively;
p
 = 0.0024). With perimitral re-entry specifically “early meets late” was closer to the anatomical region of the mitral isthmus (15.9 ± 20.9 mm vs 48.77 ± 23.23 mm, respectively;
p
 = 0.0028).
Conclusions
This study found that electroanatomical mapping acquisition with a window of interest set at the end of the P wave improves the ability to diagnose the arrhythmia mechanism based on the initial map. It is particularly beneficial in identifying area of interest for ablation in perimitral AT.