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Diagnosis and ablation of focal right atrial tachycardia using a new high-resolution, non-contact mapping system

2001; Elsevier BV; Volume: 87; Issue: 8 Linguagem: Inglês

10.1016/s0002-9149(01)01453-9

1879-1913

Heiko Schmitt, Stefan Weber, Joerg O. Schwab, Rainer M. Voss, Ralf Kneller, Harald Tillmanns, B Waldecker,

Cardiac electrophysiology and arrhythmias

Conventional electrophysiologic catheter techniques are used to identify the mechanisms and origin of cardiac tachyarrhythmias in symptomatic patients. 1 Jackman W.M. Wang X.Z. Friday K.J. Roman C.A. Moulton K.P. Beckman K.J. McClelland J.H. Twidale N. Hazlitt H.A. Prior M.I. et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med. 1991; 324: 1605-1611 Crossref PubMed Scopus (1299) Google Scholar , 2 Feld G.K. Fleck R.P. Chen P.-S. Boyce K. Bahnson T.D. Stein J.B. Calisi C.M. Ibarra M. Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques. Circulation. 1992; 86: 1233-1240 Crossref PubMed Scopus (511) Google Scholar , 3 Kay G.N. Chong F. Epstein A.E. Dailey S.M. Plumb V.J. Radiofrequency ablation for treatment of primary atrial tachycardias. J Am Coll Cardiol. 1993; 21: 901-909 Abstract Full Text PDF PubMed Scopus (194) Google Scholar , 4 Fischer B. Jais P. Shah D. Chouairi S. Haissaguerre M. Garrigues S. Poquet F. Gencel L. Clementy J. Marcus F.I. Radiofrequency catheter ablation of common atrial flutter in 200 patients. J Cardiovasc Electrophysiol. 1996; 7: 1225-1233 Crossref PubMed Scopus (95) Google Scholar , 5 Lesh M.D. Van Hare G.F. Epstein L.M. Fitzpatrick A.P. Scheinman M.M. Lee R.J. Kwasman M.A. Grogin H.R. Griffin J.C. Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms. Circulation. 1994; 89: 1074-1089 Crossref PubMed Scopus (450) Google Scholar , 6 Lee M.A. Morady F. Kadish A. Schamp D.J. Chin M.C. Scheinman M.M. Griffin J.C. Lesh M.D. Pederson D. Goldberger J. et al. Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia. Circulation. 1991; 83: 827-835 Crossref PubMed Scopus (317) Google Scholar The identified arrhythmogenic substrate can be targeted and ablated using radiofrequency current with a generally high success rate. 1 Jackman W.M. Wang X.Z. Friday K.J. Roman C.A. Moulton K.P. Beckman K.J. McClelland J.H. Twidale N. Hazlitt H.A. Prior M.I. et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med. 1991; 324: 1605-1611 Crossref PubMed Scopus (1299) Google Scholar , 7 Kay G.N. Epstein A.E. Dailey S.M. Plumb V.J. Role of radiofrequency ablation in the management of supraventricular arrhythmias experience in 760 consecutive patients. J Cardiovasc Electrophysiol. 1993; 4: 371-389 Crossref PubMed Scopus (195) Google Scholar Patients in whom the clinical arrhythmia is atypical, unstable, not readily reproducible, or poorly tolerated often require extensive and multicatheter electrophysiologic evaluation including various pacing maneuvers to confirm the tachycardia mechanism and origin. 8 Chen S.A. Chiang C.E. Yang C.J. Cheng C.C. Wu T.J. Wang S.P. Chiang B.N. Chang M.S. Radiofrequency catheter ablation of sustained intra-atrial reentrant tachycardia in adult patients. Identification of electrophysiological characteristics and endocardial mapping techniques. Circulation. 1993; 88: 578-587 Crossref PubMed Scopus (100) Google Scholar , 9 Kadish A.H. Morady F. The response of paroxysmal supraventricular tachycardia to overdrive atrial and ventricular pacing can it help determine the tachycardia mechanism?. J Cardiovasc Electrophysiol. 1993; 4: 239-252 Crossref PubMed Scopus (41) Google Scholar Ablation procedures in these patients are time consuming and sometimes unsuccessful and may be related in part to conventional catheter techniques allowing only recordings from a limited amount of sites simultaneously. Therefore, to overcome the limitations in mapping methods, new mapping techniques and catheters have recently been introduced. 10 Schmitt C. Zrenner B. Schneider M. Karch M. Ndrepepa G. Deisenhofer I. Weyerbrock S. Schreieck J. Schomig A. Clinical experience with a novel multielectrode basket catheter in right atrial tachycardias. Circulation. 1999; 99: 2414-2422 Crossref PubMed Scopus (94) Google Scholar , 11 Schilling R.J. Peters N.S. Davies D.W. Feasibility of a noncontact catheter for endocardial mapping of human ventricular tachycardia. Circulation. 1999; 99: 2543-2552 Crossref PubMed Scopus (182) Google Scholar , 12 Gepstein L. Hayam G. Ben-Haim S.A. A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation. 1997; 95: 1611-1622 Crossref PubMed Scopus (702) Google Scholar One of these is a high-resolution non-contact mapping system designed to create endocardial activation maps of the surrounding chamber by recording from >3,300 sites simultaneously and to guide ablation catheters to potential ablation sites. Clinical experience of this new technology in humans is still very limited. 11 Schilling R.J. Peters N.S. Davies D.W. Feasibility of a noncontact catheter for endocardial mapping of human ventricular tachycardia. Circulation. 1999; 99: 2543-2552 Crossref PubMed Scopus (182) Google Scholar , 13 Schilling R.J. Peters N.S. Davies D.W. Simultaneous endocardial mapping in the human left ventricle using a noncontact catheter comparison of contact and reconstructed electrograms during sinus rhythm. Circulation. 1998; 98: 887-898 Crossref PubMed Scopus (280) Google Scholar , 14 Schilling R.J. Davies D.W. Peters N.S. Characteristics of sinus rhythm electrograms at sites of ablation of ventricular tachycardia relative to all other sites a noncontact mapping study of the entire left ventricle. J Cardiovasc Electrophysiol. 1998; 9: 921-933 Crossref PubMed Scopus (49) Google Scholar Therefore, we investigated the clinical performance, safety, and efficacy of the system as a diagnostic and therapeutic tool in patients with focal right atrial tachycardias. It was the purpose of the study to rapidly determine the tachycardia origin and to ablate the arrhythmia using the nonfluoroscopic-guiding capabilities of the non-contact mapping system.