Jae-Sun Uhm1, Nam Kyun Kim2, Hancheol Lee1, Tae-Hoon Kim1, Boyoung Joung1, Hui-Nam Pak1, Moon-Hyoung Lee3. 1. Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, South Korea, 120-752. 2. Department of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, South Korea. 3. Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, South Korea, 120-752. mhlee@yuhs.ac.
Abstract
PURPOSE: Right atrial (RA) tachyarrhythmias are not rare in patients with congenital heart disease and a history of cardiac surgery. This study investigated the usefulness of a crista catheter for 3-dimensional electroanatomical mapping of RA tachyarrhythmias. METHODS: We consecutively included 35 patients (age, 43.2 ± 15.6 years; 15 men) who underwent an electrophysiological study with 3-dimensional electroanatomical mapping for RA tachycardia or flutter. In 13 patients with atrial flutter, we recorded and compared the electrical sequence in the anterior and posterior portions of the RA lateral wall. We used a crista catheter as a mapping catheter for 3-dimensional mapping in 12 patients (crista group), a lasso catheter in 12 patients (lasso group), and an ablation catheter in 11 patients (ablation group). We compared the 3-dimensional mapping points, time, and speed (mapping points per minute) among the groups. RESULTS: Atrial flutter was confirmed as cavotricuspid isthmus-dependent in all patients whose two atrial electrical sequences were the same direction and as atypical (including scar-related and dual-loop) in all patients whose sequences were in the opposite direction. Mapping speed in the crista group was significantly faster than in the lasso and ablation groups: median (interquartile range) 44.0 (35.5-69.4) points/min, 23.7 (17.8-29.8) points/min, and 8.2 (4.8-11.0) points/min, respectively (p = 0.001). CONCLUSIONS: A crista catheter is useful for high-density 3-dimensional electroanatomical mapping of complex RA tachyarrhythmias. Comparison of the electrical sequences in the anterior and posterior portions of the RA lateral wall is helpful for differentiating between cavotricuspid isthmus-dependent and atypical atrial flutter.
PURPOSE: Right atrial (RA) tachyarrhythmias are not rare in patients with congenital heart disease and a history of cardiac surgery. This study investigated the usefulness of a crista catheter for 3-dimensional electroanatomical mapping of RA tachyarrhythmias. METHODS: We consecutively included 35 patients (age, 43.2 ± 15.6 years; 15 men) who underwent an electrophysiological study with 3-dimensional electroanatomical mapping for RA tachycardia or flutter. In 13 patients with atrial flutter, we recorded and compared the electrical sequence in the anterior and posterior portions of the RA lateral wall. We used a crista catheter as a mapping catheter for 3-dimensional mapping in 12 patients (crista group), a lasso catheter in 12 patients (lasso group), and an ablation catheter in 11 patients (ablation group). We compared the 3-dimensional mapping points, time, and speed (mapping points per minute) among the groups. RESULTS:Atrial flutter was confirmed as cavotricuspid isthmus-dependent in all patients whose two atrial electrical sequences were the same direction and as atypical (including scar-related and dual-loop) in all patients whose sequences were in the opposite direction. Mapping speed in the crista group was significantly faster than in the lasso and ablation groups: median (interquartile range) 44.0 (35.5-69.4) points/min, 23.7 (17.8-29.8) points/min, and 8.2 (4.8-11.0) points/min, respectively (p = 0.001). CONCLUSIONS: A crista catheter is useful for high-density 3-dimensional electroanatomical mapping of complex RA tachyarrhythmias. Comparison of the electrical sequences in the anterior and posterior portions of the RA lateral wall is helpful for differentiating between cavotricuspid isthmus-dependent and atypical atrial flutter.
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