Skip to main content
SpringerLink
Log in

High-density mapping with fragmentation analysis in patients with reentrant atrial tachycardias (MAP-FLURHY study)

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Reentrant atrial tachycardias (ATs) use areas of slow conduction that can be visualized as fragmented electrograms. We aimed to test an ablation strategy based on the identification and ablation of spots with fragmented electrograms in reentrant ATs, using Rhythmia navigation system.

Methods

All consecutive patients from June 2016 to June 2019 were included. The IntellaMap ORION Catheter was used to detect sites with fragmentation, arbitrarily defined as fragmented electrograms > 70 ms. Entrainment was used to check if these areas belonged to the AT circuit. Ablation targeted the longest fragmented electrogram within the circuit: focal ablation for microreentries and lines for macroreentries. Ablation success was defined from each AT as conversion to sinus rhythm or another AT.

Results

Twenty-seven consecutive patients with 44 mappable ATs were included. All ATs showed sites with fragmented electrograms (104 sites; 2.4 sites per AT); 43/44 ATs had fragmented electrograms within the circuit, which were the target of ablation. Ablation success: 34/36 ATs (94%); success could not be assessed in 8 circuits, in 6 due to mechanical conversion to sinus rhythm at the target fragmented site. Fragmented electrograms within the AT circuits were longer than electrograms outside the circuits (110 ± 30 vs 90 ± 15 ms, p < 0.001). A fragmentation duration > 100 ms/ > 40% of the AT cycle length predicted to be a successful site for ablation with 72.3%/73.8% specificity, respectively. Sixty-two percent of the patients were free from atrial arrhythmias at 1 year.

Conclusions

Most ATs had detectable fragmented electrograms within the circuit, which could be the target of ablation with high efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Data availability

Anonymized data from individual patients was collected in a dedicated database and is available under request.

Code availability

Not applicable.

References

  1. Ouyang F, Ernst S, Vogtmann T, Goya M, Volkmer M, Schaumann A, Bansch D, Antz M, Kuck K-H. Characterization of reentrant circuits in left atrial macroreentrant tachycardia: critical isthmus block can prevent atrial tachycardia recurrence. Circulation. 2002;105:1934–42.

    Article  Google Scholar 

  2. Frontera A, Takigawa M, Martin R, Thompson N, Cheniti G, Massoullié G, Duchateau J, Wielandts JY, Teijeira E, Kitamura T, Wolf M, Al-Jefairi N, Vlachos K, Yamashita S, Amraoui S, Denis A, Hocini M, Cochet H, Sacher F, Jaïs P, Haïssaguerre M, Derval N. Electrogram signature of specific activation patterns: analysis of atrial tachycardias at high-density endocardial mapping. Heart Rhythm. 2018;15:28–37.

    Article  Google Scholar 

  3. Patel AM, d’Avila A, Neuzil P, Kim SJ, Mela T, Singh JP, Ruskin JN, Reddy VY. Atrial tachycardia after ablation of persistent atrial fibrillation: identification of the critical isthmus with a combination of multielectrode activation mapping and targeted entrainment mapping. Circ Arrhythm Electrophysiol. 2008;12:1047–9.

    Google Scholar 

  4. Strisciuglio T, Vandersickel N, Lorenzo G, Van Nieuwenhuyse E, El Haddad M, De Pooter J, Kyriakopoulou M, Almorad A, Lycke M, Vandekerckhove Y, Tavernier R, Duytschaever M, Knecht S. Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias. Heart Rhythm. 2020;17:211–9.

    Article  Google Scholar 

  5. Anter E, McElderry TH, Contreras-Valdes FM, Li J, Tung P, Leshem E, Haffajee CI, Nakagawa H, Josephson ME. Evaluation of a novel high-resolution mapping technology for ablation of recurrent scar-related atrial tachycardias. Heart Rhythm. 2016;13:2048–55.

    Article  Google Scholar 

  6. Takigawa M, Derval N, Frontera A, Martin R, Yamashita S, Cheniti G, Vlachos K, Thompson N, Kitamura T, Wolf M, Massoullie G, Martin CA, Al-Jefairi N, Amraoui S, Duchateau J, Klotz N, Pambrun T, Denis A, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jais P. Revisiting anatomic macroreentrant tachycardia after atrial fibrillation ablation using ultrahigh-resolution mapping: implications for ablation. Heart Rhythm. 2018;15:326–33.

    Article  Google Scholar 

  7. Saoudi N, Cosio F, Waldo A, Chen S-A, Iesaka Y, Lesh M, Saksena S, Salerno J, Schoels W. Classification of atrial flutter and regular atrial tachycardia according to electrophysiologic mechanism and anatomic bases: a statement from a joint expert group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. J Cardiovasc Electrophysiol. 2001;12:852–66.

    Article  CAS  Google Scholar 

  8. Lellouche N, Buch E, Celigoj A, Siegerman C, Cesario D, De Diego C, Mahajan A, Boyle NG, Wiener I, Garfinkel A, Shivkumar K. Functional characterization of atrial electrograms in sinus rhythm delineates sites of parasympathetic innervation in patients with paroxysmal atrial fibrillation. J Am Coll Cardiol. 2007;50:1324–31.

    Article  Google Scholar 

  9. Van der Does LJ, de Groot NM. Inhomogeneity and complexity in defining fractionated electrograms. Heart Rhythm. 2017;14:616–24.

    Article  Google Scholar 

  10. Laţcu DG, Bun SS, Viera F, Delassi T, El Jamili M, Al Amoura A, Saoudi N. Selection of critical isthmus in scar-related atrial tachycardia using a new automated ultrahigh resolution mapping system. Circ Arrhythm Electrophysiol. 2017;10:e004510.

    Article  Google Scholar 

  11. Coffey JO, d’Avila A, Dukkipati S, Danik SB, Gangireddy SR, Koruth JS, Miller MA, Sager SJ, Eggert CA, Reddy VY. Catheter ablation of scar-related atypical atrial flutter. Europace. 2013;15:414–9.

    Article  Google Scholar 

  12. Ammar S, Luik A, Hessling G, Bruhm A, Reents T, Semmler V, Buiatti A, Kathan S, Hofmann M, Kolb C, Schmitt C, Deisenhofer I. Ablation of perimitral flutter: acute and long-term success of the modified anterior line. Europace. 2015;17:447–52.

    Article  Google Scholar 

  13. Enriquez A, Santangeli P, Zado ES, Liang J, Castro S, Garcia FC, Schaller RD, Supple GE, Frankel DS, Callans DJ, Lin D, Dixit S, Deo R, Riley MP, Marchlinski FE. Postoperative atrial tachycardias after mitral valve surgery: mechanisms and outcomes of catheter ablation. Heart Rhythm. 2017;14:520–6.

    Article  Google Scholar 

  14. Zhou GB, Hu JQ, Guo XG, Liu X, Yang JD, Sun Q, Ma J, Ouyang FF, Zhang S. Very long-term outcome of catheter ablation of post-incisional atrial tachycardia: role of incisional and non-incisional scar. Int J Cardiol. 2016;205:72–80.

    Article  Google Scholar 

  15. Winkle RA, Moskovitz R, Mead RH, Engel G, Kong MH, Fleming W, Patrawala RA. Ablation of atypical atrial flutters using ultra high density-activation sequence mapping. J Interv Card Electrophysiol. 2017;48:177–84.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain

    Eduardo Franco, Cristina Lozano Granero, Roberto Matía, Antonio Hernández-Madrid, José Luis Zamorano & Javier Moreno

  2. Pediatric Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain

    Inmaculada Sánchez

Authors
  1. Eduardo Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Lozano Granero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Matía
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Hernández-Madrid
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Inmaculada Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. José Luis Zamorano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Javier Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eduardo Franco.

Ethics declarations

Ethics approval

The study complied with the Declaration of Helsinki and received prior approval by the ethics committee of our institution.

Consent to participate

Written informed consent was obtained before the procedures, and patient data were collected in a dedicated database.

Consent for publication

Written informed consent was obtained before the procedures, and patient data were collected in a dedicated database.

Conflict of interest

Dr. Javier Moreno has received consulting fees from Boston Medical. The rest of the authors declare no conflicts of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 KB)

10840_2021_1012_MOESM2_ESM.jpg

Fig. S1 Progressive fusion and reset observed with entrainment from two different sites in a microreentry. A) Entrainment from the left atrium (distal coronary sinus), with return cycle = 540 ms – 330 ms = 210 ms. B) Entrainment from the right atrium (low lateral free wall), with return cycle = 414 ms – 330 ms = 74 ms. C) Fragmented EGMs recorded with the IntellaMap ORION catheter at the earliest site of the propagation map, located in the lateral wall of the right atrium; from this site, entrainment was possible and return cycle was 0 ms. Focal ablation was successful to terminate the tachycardia. Note the low voltage of the fragmented EGMs. ORB = Woven Orbiter catheter; blue dipoles around the tricuspid annulus, green dipoles into the coronary sinus. Paper speed: 67 mm/s in A) and B); 200 mm/s in C). (JPG 844 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Franco, E., Lozano Granero, C., Matía, R. et al. High-density mapping with fragmentation analysis in patients with reentrant atrial tachycardias (MAP-FLURHY study). J Interv Card Electrophysiol 63, 513–522 (2022). https://doi.org/10.1007/s10840-021-01012-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-021-01012-z

Keywords

Search

Navigation