Pattern and timing of the coronary sinus activation to guide rapid diagnosis of atrial tachycardia after atrial fibrillation ablation.

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State: Public
Version: Final published version
Serval ID
serval:BIB_B256EB50D1B4
Type
Article: article from journal or magazin.
Collection
Publications
Title
Pattern and timing of the coronary sinus activation to guide rapid diagnosis of atrial tachycardia after atrial fibrillation ablation.
Journal
Circulation. Arrhythmia and Electrophysiology
Author(s)
Pascale P., Shah A.J., Roten L., Scherr D., Komatsu Y., Jadidi A.S., Ramoul K., Daly M., Denis A., Wilton S.B., Derval N., Sacher F., Hocini M., Haïssaguerre M., Jaïs P.
ISSN
1941-3084 (Electronic)
ISSN-L
1941-3084
Publication state
Published
Issued date
2013
Volume
6
Number
3
Pages
481-490
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Abstract
BACKGROUND: Atrial tachycardias (AT) during or after ablation of atrial fibrillation frequently pose a diagnostic challenge. We hypothesized that both the patterns and the timing of coronary sinus (CS) activation could facilitate AT mapping.
METHODS AND RESULTS: A total of 140 consecutive postpersistent atrial fibrillation ablation patients with sustained AT were investigated by conventional mapping. CS activation pattern was defined as chevron or reverse chevron when the activations recorded on both the proximal and the distal CS dipoles were latest or earliest, respectively. The local activation of mid-CS was timed with reference to Ppeak-Ppeak (P-P) interval in lead V1. A ratio, mid-CS activation time to AT cycle length, was computed. Of 223 diagnosed ATs, 124 were macroreentrant (56%) and 99 were centrifugal (44%). When CS activation was chevron/reverse chevron (n=44; 20%), macroreentries were mostly roof dependent. With reference to P-P interval, mid-CS activation timing showed specific consistency for peritricuspid and perimitral AT. Proximal to distal CS activation pattern and mid-CS activation at 50% to 70% of the P-P interval (n=30; 13%) diagnosed peritricuspid AT with 81% sensitivity and 89% specificity. Distal to proximal CS activation and mid-CS activation at 10% to 40% of the P-P interval (n=44; 20%) diagnosed perimitral AT with 88% sensitivity and 75% specificity.
CONCLUSIONS: The analysis of the patterns and timing of CS activation provides a rapid stratification of most likely macroreentrant ATs and points toward the likely origin of centrifugal ATs. It can be included in a stepwise diagnostic approach to rapidly select the most critical mapping maneuvers.
Keywords
Aged, Atrial Fibrillation/diagnosis, Atrial Fibrillation/surgery, Body Surface Potential Mapping/methods, Catheter Ablation/adverse effects, Catheter Ablation/methods, Cohort Studies, Coronary Sinus, Early Diagnosis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Monitoring, Intraoperative/methods, Postoperative Care/methods, Preoperative Care/methods, Retrospective Studies, Risk Assessment, Severity of Illness Index, Tachycardia, Ectopic Atrial/diagnosis, Tachycardia, Ectopic Atrial/etiology, Time Factors, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
15/07/2014 8:20
Last modification date
20/08/2019 15:21
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