Coherent Mapping of Atrial Tachycardias in Patients with Congenital Heart Disease

Background: Atrial tachycardias (AT) in patients with congenital heart disease (CHD) are significantly contributing to morbidity and mortality. Identification of critical conduction isthmuses is difficult in this patient population. The Coherent mapping uses a new algorithm to identify areas of electrical discontinuity and displays conduction velocity vectors to better identify critical sites for ablation. We analyzed our experience of ablation of AT with this new technology.

Method: All patients with CHD who had the Coherent mapping of AT using the high-density mapping pentaray catheter and three-dimensional electroanatomic mapping system Carto 3 between June 2019 and June 2021 were included retrospectively.

Results: A total of 27 ablation procedures were performed in 26 CHD patients (age: 40 ± 17 years, 10 females). Twenty-nine AT were induced and mapped. Twenty-five AT were intra-atrial reentrant tachycardia (thereof 14 isthmus dependent) and four AT were of focal origin. Critical conduction isthmus or breakout site could be identified in all procedures. Acute success was 100%. Mean procedure duration was 199 ± 67 minutes and mean fluoroscopy time was 10.8 ± 7.4 minutes. Substrates were located in the right atrium/systemic venous atrium in eight procedures, located in the left atrium/pulmonary venous atrium in seven procedures and located in both atria in 10 procedures. AT recurred in nine patients, thereof two needed a reprocedure (mean follow-up: 10 ± 8 months). No complications occurred.

Conclusion: Coherent mapping of AT using high density mapping pentaray catheter showed excellent results regarding acute success and promising results regarding procedure duration, fluoroscopy time, and recurrence rate. Coherent mapping simplifies the identification of critical slow conducting isthmuses for ablation of AT in this patients cohort with a high percentage of scar-related ATs.

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Artikel online veröffentlicht:
12. Februar 2022