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Complex atrial arrhythmias: are we closer to find the way to success?

Session Moderated ePosters 1: non-invasive rhythm diagnostics: bringing old and new together

Speaker Ines Aguiar Ricardo

Event : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Arrhythmias, General – Diagnostic Methods: Electrocardiography
  • Session type : Moderated Posters

Authors : I Aguiar Ricardo (Lisbon,PT), IS Goncalves (Lisbon,PT), IS Goncalves (Lisbon,PT), J Rigueira (Lisbon,PT), J Rigueira (Lisbon,PT), A Nunes-Ferreira (Lisbon,PT), A Nunes-Ferreira (Lisbon,PT), R Santos (Lisbon,PT), R Santos (Lisbon,PT), T Rodrigues (Lisbon,PT), T Rodrigues (Lisbon,PT), J Agostinho (Lisbon,PT), J Agostinho (Lisbon,PT), N Cunha (Lisbon,PT), N Cunha (Lisbon,PT), J Quaresma (Lisbon,PT), J Quaresma (Lisbon,PT), A Bernardes (Lisbon,PT), A Bernardes (Lisbon,PT), N Cortez-Dias (Lisbon,PT), N Cortez-Dias (Lisbon,PT), L Carpinteiro (Lisbon,PT), L Carpinteiro (Lisbon,PT), FJ Pinto (Lisbon,PT), FJ Pinto (Lisbon,PT), J Sousa (Lisbon,PT), J Sousa (Lisbon,PT)

Authors:
I Aguiar Ricardo1 , IS Goncalves1 , IS Goncalves1 , J Rigueira1 , J Rigueira1 , A Nunes-Ferreira1 , A Nunes-Ferreira1 , R Santos1 , R Santos1 , T Rodrigues1 , T Rodrigues1 , J Agostinho1 , J Agostinho1 , N Cunha1 , N Cunha1 , J Quaresma1 , J Quaresma1 , A Bernardes1 , A Bernardes1 , N Cortez-Dias1 , N Cortez-Dias1 , L Carpinteiro1 , L Carpinteiro1 , FJ Pinto1 , FJ Pinto1 , J Sousa1 , J Sousa1 , 1Cardiology Department, Santa Maria Hospital, CHLN, CCUL, Lisbon University, Cardiology - Lisbon - Portugal ,

Citation:

Introduction: Complex atrial arrhythmias (CAA) are usualy secondary to complex structural substrate modifications (heterogeneous myocardial fibrosis), making their mapping and ablation a true challenge. The emergence of high density mapping (allowing detailed substrate evaluation) and of innovative algorithms, not dependent on the definition of a window-of-interest (such as RippleMapTM and SparkleMapTM), has allowed us to investigate new mapping methodologies and avoid the use of potentially deleterious entrainment maneuvers during the procedure (arrhythmia instability).

Purpose: Evaluation of the success of a structured methodology of high density mapping of CAA, primarily based on the analysis of algorithms that are independent of a window-of-interest

Métodos: It was conducted an unicentric prospective study of consecutive patients with CAA submitted to electrophysiological study since June 2015. The mapping methodology was based on three principles: non-use of entrainment maneuvers; acquisition of the high density bipolar voltage map for detailed characterization of the substrate; interpretation of the arrhythmia mechanism by the analysis of the electrical propagation sequence represented by the RippleMapTM or SparkleMapTM (keeping activation map concealed).

Results: Thirty-five procedures were performed (63% men; mean age 66 years). Previous history of ablation was present in 54% of the patients (pulmonary vein isolation in 40%). The majority of the CAA studied (80%) had origin in the left atrium and 20% in the right atrium. The average of points collected per map was 2933, with a total mapping time of 37±19min and a map interpretation time of 28±16min. The arrhythmogenic mechanism was clearly identified in 97%: 71% macro-reentry, 20% focal origin, 5.7% micro-reentry; only 1 case was uninterpretable. In 86% of the cases, the CAA was terminated with first radiofrequency application and success was obtained in 83% (5 cases of failure due to inability to block the mitral isthmus and one case due to inability to block the roof line).

Conclusion: Our strategy of CAA mapping and ablation allowed the appropriate identification of the arrhythmia mechanism in 97% of the cases, leading to a more directed and circumscribed ablation strategy.

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