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A new electrophysiological triad for atrial flutter critical isthmus identification and localization
Session:
CO 03 - Flutter/atrial fibrilation
Speaker:
Pedro Adragão
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
06. Supraventricular Tachycardia (non-AF)
Subtheme:
06.4 Supraventricular Tachycardia (non-AF) - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Adragão; Daniel Matos; Pedro Galvão Santos; Francisco Costa; Gustavo Rodrigues; João Carmo; Pedro Carmo; Diogo Cavaco; Francisco Morgado; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Arial",sans-serif">Introduction:</span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:"Arial",sans-serif">In a previous retrospective study it was demonstrated that an electrophysiological triad was able to identify critical isthmus in atrial flutter (AFL) patients. This triad is based in th<span style="color:black">e Carto® electroanatomical mapping (EAM) version 7, which displays a histogram of the local activation times (LAT) of the tachycardia cycle length (TCL), in addition to the activation and voltage maps. This </span>study aimed to prospectively assess the ability of an electrophysiological triad to identify and localize the AFL’s critical isthmus.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Arial",sans-serif">Methods:</span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:"Arial",sans-serif">Prospective analysis of a unicentric registry of individuals who underwent left AFL ablation with Carto® EAM. All patients with non-left AFL, lack of high-density EAM, less than 2000 collected points or lack of mapping in any of the left atrium walls or structures were excluded. <span style="color:black">Ablation sites of arrhythmia termination were compared to an electrophysiological triad constituted by: areas of low-voltage (0.05 to 0.3mV), sites of deep histogram valleys (LAT-Valleys) with less than 20% density points relative to the highest density zone and a prolonged LAT-Valley duration that included 10% or more of the TCL. The longest LAT-Valley was designated as the primary valley, while additional valleys were named as secondary.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Arial",sans-serif">Results:</span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:"Arial",sans-serif">A total of 12 patients (9 men, median age 72 IQR 67-75 years) were included. All patients presented with left AFL and 67% had a previous atrial fibrillation and/or flutter ablation. The median TCL and number collected points were 250 (230-290) milliseconds and 3150 (IQR 2340-3870) points, respectively. All AFL presented with at least 1 LAT-Valley in the analysed histograms, which corresponded to heterogeneous low-voltage areas <span style="color:black">(0.05 to 0.3mV) and encompassed more than 10% of TCL. Eleven of the 12 patients presented with at least 1 secondary LAT-Valley.</span> All arrhythmias were effectively terminated after undergoing radiofrequency ablation in the primary or the secondary LAT-Valley location<span style="color:red">.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.5pt"><span style="font-family:"Arial",sans-serif">Conclusion:</span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">In a prospective analysis, an electrophysiological triad was able to identify the AFL critical isthmus in all patients.</span></span></span><span style="font-size:10.5pt"><span style="font-family:"Arial",sans-serif"> Further studies are needed to assess the usefulness of this algorithm to improve catheter ablation outcomes.</span></span></span></span></p>
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