Skip Navigation

European Heart Journal 2001 22(3):237-246; doi:10.1053/euhj.2001.2468
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (14)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Reithmann, C.
Right arrow Articles by Steinbeck, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Reithmann, C.
Right arrow Articles by Steinbeck, G.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Electroanatomical mapping for visualization of atrial activation in patients with incisional atrial tachycardias

C. Reithmannf1, E. Hoffmann, U. Dorwarth, T. Remp and G. Steinbeck

Medizinische Klinik I, Klinikum Großhadern, Universität München, München, Germany

Received June 20, 2000; accepted September 18, 2000

Abstract

Aims Incisional atrial tachycardias in patients following surgery for congenital heart disease are based on complex structural abnormalities in these hearts. The aim of this study was to evaluate the use of the electroanatomical mapping system, CARTO, in consecutive patients with different forms of incisional atrial tachycardia.

Methods and Results The electroanatomical mapping system combines electrophysiological and spatial information and allows visualization of atrial activation in a three-dimensional anatomical reconstruction of the atria. Electroanatomical mapping of right atrial activation was performed in 10 patients after surgery for congenital heart disease, surgery for Wolff–Parkinson–White syndrome, or heart transplantation presenting with 13 incisional atrial tachycardias. The three-dimensional mapping allowed a rapid distinction between focal (n=3) and reentrant mechanisms (n=10) and visualization of the activation wavefronts along anatomical and surgically created barriers. Electroanatomical activation maps (mean right atrial activation time 213±107ms) were constructed with 89±60 catheter positions during an average mapping time of 48±33 min. Reentrant tachycardias propagating through the tricuspid annulus–vena cava inferior isthmus (n=6) or along periatriotomy loops (n=4) were identified in eight patients. Ectopic atrial foci near surgical scars could be localized in three patients. Catheter ablation by creation of a lesion in a critical isthmus of conduction or by targeting the arrhythmogenic focus eliminated 11 of 13 incisional atrial tachycardias.

Conclusion Visualization of atrial activation in a three-dimensional reconstruction of the right atrium using the electroanatomical mapping system CARTO facilitates understanding of the mechanism and defines the reentrant circuits of incisional atrial tachycardias. This new method may improve the success rate of electrophysiologically guided and anatomically guided catheter ablation of incisional atrial tachycardias.

Key Words: Atrial tachycardia, electroanatomical mapping, catheter ablation, congenital heart disease

f1 Correspondence: Dr C. Reithmann, Medizinische Klinik I, Klinikum Großhadern, Universität München, Marchioninistr. 15D-81377 München, Germany.

References

  1. Kalman JM, VanHare GF, Olgin JF, Saxon LA, Stark SI, Lesh MD. Ablation of ‘incisional’ reentrant atrial tachycardia complicating surgery for congenital heart disease. Use of entrainment to define a critical isthmus of conduction. Circulation. 1996;93:502–512[Abstract/Free Full Text]
  2. Triedman JK, Saul JP, Weindling SN, Walsh EP. Radiofrequency ablation of intra-atrial reentrant tachycardia after surgical palliation of congenital heart disease. Circulation. 1995;91:707–714[Abstract/Free Full Text]
  3. Gepstein L, Hayam G, Ben-Haim SA. A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation. 1997;95:1611–1622[Abstract/Free Full Text]
  4. Smeets JLRM, Ben-Haim SA, Rodriguez LM, Timmermans C, Wellens HJ. New method for nonfluoroscopic endocardial mapping in humans. Accuracy assessment and first clinical results. Circulation. 1998;97:2426–2432[Abstract/Free Full Text]
  5. Shpun S, Gepstein L, Hayam G, Ben-Haim SA. Guidance of radiofrequency endocardial ablation with real-time three-dimensional magnetic navigation system. Circulation. 1997;96:2016–2021[Abstract/Free Full Text]
  6. Nakagawa H, Jackman WM. Use of a three-dimensional, nonfluoroscopic mapping system for catheter ablation of typical atrial flutter. PACE. 1998;21:1279–1286
  7. Shah DC, Jais PJ, Haissaguerre M. Three-dimensional mapping of the common atrial flutter circuit in the right atrium. Circulation. 1997;96:3904–3912[Abstract/Free Full Text]
  8. Kottkamp H, Hindricks G, Breithardt G, Borggrefe M. Three-dimensional electromagnetic catheter technology: Electroanatomical mapping of the right atrium and ablation of ectopic atrial tachycardia. J Cardiovasc Electrophys. 1997;8:1332–1337[Web of Science][Medline]
  9. Marchlinski F, Callans D, Gottlieb C, Rodriguez E, Coyne R, Kleinman D. Magnetic electroanatomical mapping for ablation of focal atrial tachycardias. PACE. 1998;21:1621–1635
  10. Leonelli F, Richey M, Beheiry S, Rajkovich K, Natale A. Tridimensional mapping: Guided modification of the sinus node. J Cardiovasc Electrophys. 1998;9:1214–1217[Web of Science][Medline]
  11. Natale A, Breeding L, Tomasoni G. Ablation of right and left ectopic atrial tachycardias using a three-dimensional nonfluoroscopic mapping system. Am J Cardiol. 1998;82:989–992[CrossRef][Web of Science][Medline]
  12. Hoffmann E, Nimmermann P, Reithmann C, Elser F, Remp T, Steinbeck G. New mapping technology for atrial tachycardias. J Intervent Cardiac Electrophysiol. 1999;4:117–120
  13. Hoffmann E, Reithmann C, Nimmermann P, Remp T, Steinbeck G. Atrial reentrant tachycardia after heart transplantation. Circulation. 1999;99:326–327[Free Full Text]
  14. Waldo AL. Transient entrainment of atrial flutter. Waldo AL, Touboul P. Atrial Flutter Advances in Mechanisms and Management. New York: Futura Publishing; 1996. p. 241–258
  15. Hoffmann E, Remp T, Gerth A, Mattke S, Steinbeck G. Does impedance monitoring during radiofrequency catheter ablation reduce the risk of impedance rise? Circulation. 1993;88:165[Abstract/Free Full Text]
  16. Poty H, Saoudi N, Aziz AA, Nair M, Lectac B. Radiofrequency catheter ablation of type 1 atrial flutter: prediction of late success by electrophysiological criteria. Circulation. 1995;92:1389–1392[Abstract/Free Full Text]
  17. Cauchemez B, Haissaguerre M, Fischer B, Thomas O, Clementy J, Coumel P. Electrophysiological effects of catheter ablation of inferior vena cava—tricuspid annulus isthmus in common atrial flutter. Circulation. 1996;93:284–294[Abstract/Free Full Text]
  18. Hebe J, Antz M, Ouyang F, Volkmer M. Mapping and ablation of incisional atrial reentry tachycardias in patients after surgery for congenital heart disease using a 3D-electroanatomical mapping system. Circulation. 1998;98:616
  19. Dorostkar PC, Cheng J, Scheinmann MM. Electroanatomical mapping and ablation of the substrate supporting intraatrial reentrant tachycardia after palliation for complex congenital heart disease. PACE. 1998;21:1810–1819
  20. Shah D, Jais P, Takahashi A. Dual-loop intra-atrial reentry in humans. Circulation. 2000;101:631–639[Abstract/Free Full Text]
  21. Baker BM, Lindsay BD, Bromberg BI, Frazier DW, Cain ME, Smith JM. Catheter ablation of clinical intraatrial reentrant tachycardias resulting from previous atrial surgery: localizing and transecting the critical isthmus. J Am Coll Cardiol. 1996;28:411–417[Abstract]
  22. Chan DP, Van Hare GF, Carlson MD, Mackall JA, Waldo A. Importance of the typical flutter isthmus in post-operative intra-atrial reentry. Circulation. 1998;98:616
  23. Jais P, Shah DC, Haissaguerre M, Clementy J. Mapping and ablation of atrial arrhythmias following surgical atrial septal defect closure. Circulation. 1998;98:281[Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Card Surg AdultHome page
R. E. Eckart and L. M. Epstein
Interventional Therapy for Atrial and Ventricular Arrhythmias
Card. Surg. Adult, January 1, 2008; 3(2008): 1357 - 1374.
[Full Text]

Home page
 J Am Coll CardiolHome page
R. M. Lang, V. Mor-Avi, L. Sugeng, P. S. Nieman, and D. J. Sahn
Three-Dimensional Echocardiography: The Benefits of the Additional Dimension
J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2053 - 2069.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
J. C. Nielsen, H. Kottkamp, C. Piorkowski, J.-H. Gerds-Li, H. Tanner, and G. Hindricks
Radiofrequency ablation in children and adolescents: results in 154 consecutive patients.
Europace, January 1, 2006; 8(5): 323 - 329.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
N. M.S. de Groot, M. J. Schalij, K. Zeppenfeld, N. A. Blom, E. T. Van der Velde, and E. E. Van der Wall
Voltage and Activation Mapping: How the Recording Technique Affects the Outcome of Catheter Ablation Procedures in Patients With Congenital Heart Disease
Circulation, October 28, 2003; 108(17): 2099 - 2106.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
S. D. Satti and L. M. Epstein
Cardiologic Interventional Therapy for Atrial and Ventricular Arrhythmias
Card. Surg. Adult, January 1, 2003; 2(2003): 1253 - 1270.
[Full Text]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (14)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Reithmann, C.
Right arrow Articles by Steinbeck, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Reithmann, C.
Right arrow Articles by Steinbeck, G.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?