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Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias

Teresa Strisciuglio, Nele Vandersickel (UGent) , Giuseppe Lorenzo, Enid Van Nieuwenhuyse, Milad El Haddad, Jan De Pooter (UGent) , Maria Kyriakopoulou, Alexandre Almorad, Michelle Lycke, Yves Vandekerckhove, et al.
(2020) HEART RHYTHM. 17(2). p.211-219
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Abstract
BACKGROUND Identification of atrial tachycardia (AT) mechanism remains challenging. OBJECTIVE We sought to investigate the added value of entrainment maneuvers (EM) when using new high-density activation mapping (HDAM) technologies for the identification of complex left ATs. METHODS Thirty-six consecutive complex ATs occurring after ablation of persistent atrial fibrillation were prospectively analyzed. The AT mechanism was diagnosed in 2 steps by 2 experts: (1) based on H DAM only (Coherent module, CARTO, Biosense Webster Inc., Irvine, CA) and (2) with additional analysis from EM. RESULTS EM resulted in atrial fibrillation in 1 patient, who was excluded from the analysis. Ten of 11 single loop macroreentries identified by HDAM were confirmed by EM. Only 4 of 14 double loop macroreentries identified by HDAM wereconfirmed by EM (in 10 patients, EM unmasked passive activation of one of the visual cir- cuits). One sole microreentry circuit identified by HDAM was confirmed by EM. A combination of macro- and microreentry circuits was visualized in 3 ATs using H DAM. However, EM revealed passive activation of the visual macroreentrant loop in 2 of these 3 cases. By using HDAM in 6 of 35 ATs (17%), no univocal mechanism could be identified, whereas EM finally enabled the diagnosis of 5 microreentry circuits and 1 macroreentrant AT. All the diagnoses made from EM in addition to HDAM were confirmed by ablation. CONCLUSION Entrainment maneuvers are still useful during mapping of complex left ATs, mostly to differentiate active from passive macroreentrant loops and to demonstrate microreentry circuits.
Keywords
Physiology (medical), Cardiology and Cardiovascular Medicine, Atrial tachycardia, Entrainment, Local activation time, High-density activation mapping, Catheter ablation, ABLATION

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MLA
Strisciuglio, Teresa, et al. “Prospective Evaluation of Entrainment Mapping as an Adjunct to New-Generation High-Density Activation Mapping Systems of Left Atrial Tachycardias.” HEART RHYTHM, vol. 17, no. 2, 2020, pp. 211–19, doi:10.1016/j.hrthm.2019.09.014.
APA
Strisciuglio, T., Vandersickel, N., Lorenzo, G., Van Nieuwenhuyse, E., El Haddad, M., De Pooter, J., … Knecht, S. (2020). Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias. HEART RHYTHM, 17(2), 211–219. https://doi.org/10.1016/j.hrthm.2019.09.014
Chicago author-date
Strisciuglio, Teresa, Nele Vandersickel, Giuseppe Lorenzo, Enid Van Nieuwenhuyse, Milad El Haddad, Jan De Pooter, Maria Kyriakopoulou, et al. 2020. “Prospective Evaluation of Entrainment Mapping as an Adjunct to New-Generation High-Density Activation Mapping Systems of Left Atrial Tachycardias.” HEART RHYTHM 17 (2): 211–19. https://doi.org/10.1016/j.hrthm.2019.09.014.
Chicago author-date (all authors)
Strisciuglio, Teresa, Nele Vandersickel, Giuseppe Lorenzo, Enid Van Nieuwenhuyse, Milad El Haddad, Jan De Pooter, Maria Kyriakopoulou, Alexandre Almorad, Michelle Lycke, Yves Vandekerckhove, René Tavernier, Mattias Duytschaever, and Sebastien Knecht. 2020. “Prospective Evaluation of Entrainment Mapping as an Adjunct to New-Generation High-Density Activation Mapping Systems of Left Atrial Tachycardias.” HEART RHYTHM 17 (2): 211–219. doi:10.1016/j.hrthm.2019.09.014.
Vancouver
1.
Strisciuglio T, Vandersickel N, Lorenzo G, Van Nieuwenhuyse E, El Haddad M, De Pooter J, et al. Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias. HEART RHYTHM. 2020;17(2):211–9.
IEEE
[1]
T. Strisciuglio et al., “Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias,” HEART RHYTHM, vol. 17, no. 2, pp. 211–219, 2020.
@article{8643000,
  abstract     = {{BACKGROUND Identification of atrial tachycardia (AT) mechanism remains challenging.

OBJECTIVE We sought to investigate the added value of entrainment maneuvers (EM) when using new high-density activation mapping (HDAM) technologies for the identification of complex left ATs.

METHODS Thirty-six consecutive complex ATs occurring after ablation of persistent atrial fibrillation were prospectively analyzed. The AT mechanism was diagnosed in 2 steps by 2 experts: (1) based on H DAM only (Coherent module, CARTO, Biosense Webster Inc., Irvine, CA) and (2) with additional analysis from EM.

RESULTS EM resulted in atrial fibrillation in 1 patient, who was excluded from the analysis. Ten of 11 single loop macroreentries identified by HDAM were confirmed by EM. Only 4 of 14 double loop macroreentries identified by HDAM wereconfirmed by EM (in 10 patients, EM unmasked passive activation of one of the visual cir- cuits). One sole microreentry circuit identified by HDAM was confirmed by EM. A combination of macro- and microreentry circuits was visualized in 3 ATs using H DAM. However, EM revealed passive activation of the visual macroreentrant loop in 2 of these 3 cases. By using HDAM in 6 of 35 ATs (17%), no univocal mechanism could be identified, whereas EM finally enabled the diagnosis of 5 microreentry circuits and 1 macroreentrant AT. All the diagnoses made from EM in addition to HDAM were confirmed by ablation.

CONCLUSION Entrainment maneuvers are still useful during mapping of complex left ATs, mostly to differentiate active from passive macroreentrant loops and to demonstrate microreentry circuits.}},
  author       = {{Strisciuglio, Teresa and Vandersickel, Nele and Lorenzo, Giuseppe and Van Nieuwenhuyse, Enid and El Haddad, Milad and De Pooter, Jan and Kyriakopoulou, Maria and Almorad, Alexandre and Lycke, Michelle and Vandekerckhove, Yves and Tavernier, René and Duytschaever, Mattias and Knecht, Sebastien}},
  issn         = {{1547-5271}},
  journal      = {{HEART RHYTHM}},
  keywords     = {{Physiology (medical),Cardiology and Cardiovascular Medicine,Atrial tachycardia,Entrainment,Local activation time,High-density activation mapping,Catheter ablation,ABLATION}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{211--219}},
  title        = {{Prospective evaluation of entrainment mapping as an adjunct to new-generation high-density activation mapping systems of left atrial tachycardias}},
  url          = {{http://doi.org/10.1016/j.hrthm.2019.09.014}},
  volume       = {{17}},
  year         = {{2020}},
}
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