Journal of Interventional Cardiac Electrophysiology, Jan 24, 2022
Background Arrhythmic death is very common among patients with structural heart disease, and it i... more Background Arrhythmic death is very common among patients with structural heart disease, and it is estimated that in European countries, 1 per 1000 inhabitants yearly dies for sudden cardiac death (SCD), mainly as a result of ventricular arrhythmias (VA). The scar is the result of cardiac remodelling process that occurs in several cardiomyopathies, both ischemic and non-ischemic, and is considered the perfect substrate for re-entrant and non-re-entrant arrhythmias. Methods Our aim was to review published evidence on the histological and electrophysiological properties of myocardial scar and to review the central role of cardiac magnetic resonance (CMR) in assessing ventricular arrhythmias substrate and its potential implication in risk stratification of SCD. Results Scarring process affects both structural and electrical myocardial properties and paves the background for enhanced arrhythmogenicity. Non-uniform anisotropic conduction, gap junctions remodelling, source to sink mismatch and refractoriness dispersion are some of the underlining mechanisms contributing to arrhythmic potential of the scar. All these mechanisms lead to the initiation and maintenance of VA. CMR has a crucial role in the evaluation of patients suffering from VA, as it is considered the gold standard imaging test for scar characterization. Mounting evidences support the use of CMR not only for the definition of gross scar features, as size, localization and transmurality, but also for the identification of possible conducting channels suitable of discrete ablation. Moreover, several studies call out the CMR-based scar characterization as a stratification tool useful in selecting patients at risk of SCD and amenable to implantable cardioverter-defibrillator (ICD) implantation. Conclusions Scar represents the substrate of ventricular arrhythmias. CMR, defining scar presence and its features, may be a useful tool for guiding ablation procedures and for identifying patients at risk of SCD amenable to ICD therapy.
Pacing and Clinical Electrophysiology, Jun 4, 2019
The mechanisms of AF induction and maintenance, including those involved in paroxysmal atrial fib... more The mechanisms of AF induction and maintenance, including those involved in paroxysmal atrial fibrillation, are not completely known; this limits our ablation strategies and prevents us from This article is protected by copyright. All rights reserved. 2 understanding what we are actually doing when performing pulmonary vein isolation. In this report, we focus on the commonly used ablation strategies for atrial fibrillation and question the importance of complete pulmonary vein isolation in achieving lasting success in the ablation of atrial fibrillation. We also discuss in detail the absence of durable pulmonary vein isolation in patients without arrhythmic recurrences after atrial fibrillation ablation and the possibility to cure paroxysmal atrial fibrillation without concomitant pulmonary vein isolation, provocatively questioning the dogma of pulmonary vein isolation as the cornerstone of atrial fibrillation ablation. Finally, a prospective personalized approach in the individual patient is advocated.
Despite the technical improvements made in recent years, the overall long-term success rate of ve... more Despite the technical improvements made in recent years, the overall long-term success rate of ventricular tachycardia (VT) ablation in patients with ischemic cardiomyopathy remains disappointing. This unsatisfactory situation has persisted even though several approaches to VT substrate ablation allow mapping and ablation of noninducible/nontolerated arrhythmias. The current substrate mapping methods present some shortcomings regarding the accurate definition of the true scar, the modality of detection in sinus rhythm of abnormal electrograms that identify sites of critical channels during VT and the possibility to determine the boundaries of functional re-entrant circuits during sinus or paced rhythms. In this review, we focus on current and proposed ablation strategies for VT to provide an overview of the potential/real application (and results) of several ablation approaches and future perspectives.
JPs seemed to have a converse distribution across the KTand they were mainly observed in the mid-... more JPs seemed to have a converse distribution across the KTand they were mainly observed in the mid-postero-septal region (73.3%). After 359±121 days of follow-up, no patients had a recurrence of AVNRT. Conclusion: The exact anatomical site and pathways involved in AVNRT are still unclear as well as the analysis and characterisation of the AVN potential. Our results represent the first evidence of the recording of AVN potential. Further studies and technological improvements are needed to confirm our results.
Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve d... more Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavXguided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.
Background: Activation mapping of Koch's Triangle, even when coupled with high density mapping, i... more Background: Activation mapping of Koch's Triangle, even when coupled with high density mapping, is incomplete without recordings of AV nodal electrical activity. Purpose: To identify, through a highly specific methodology and high-density electro-anatomical mapping (HDM), the slow AVN potential (AVNP) and the precise activation modality of Koch's Triangle in SR in atrio-ventricular nodal reentrant tachycardia (AVNRT) patients.
Backgrounds: Ablation procedures, cardiac surgeries, and extensive fibrosis may create the substr... more Backgrounds: Ablation procedures, cardiac surgeries, and extensive fibrosis may create the substrate of complex ATs. In these ATs, to predict the impact of ablation and the subsequent circuit of the second tachycardia is sometimes difficult. We aimed to elucidate the simple algorithm to predict the behavior of AT during radiofrequency application from the primary activation map of high-density mapping system. Methods: A simple algorithm for predicting termination/conversion of AT and the subsequent second AT circuit, associated with the ablation site, was developed from 71 index AT-activation map (retrospective phase) using high-density mapping system. The algorithm showed the sensitivity of 98.3% and the specificity of 83.3% to predict the termination/change of AT during ablation and the subsequent second AT circuit. This algorithm was subsequently tested prospectively in 188 consecutive ATs in 135 patients () (Prospective phase). Result: 13 focal ATs, 20 ATs without complete activation map, and 5 undiagnosed ATs with complete activation map was excluded from the study. Among 150 ATs, 115 ATs were predicted to be terminated, among which 5/115 (4.3%) was converted to another AT. Thirty-five ATs were predicted to be converted to another AT, among which 1/35 (2.9%) was terminated. The sensitivity and the specificity to predict termination/conversion of AT during ablation was 99.1% and 87.2% in total, 100% and 80.0% in macroreentrant AT, 100% and 90.9% in non-macroreentrant ATs, and 91.7% and 92.3% in deal-loop AT, respectively. Five ATs which were supposed to be terminated but to convert to the second ATs used the other atrral chamber or the epicardial structure in the second AT circuit. Conclusions: With the high-density mapping system, termination/conversion of the AT and the subsequent AT circuit was highly predictable from the index activation map.
Journal of Interventional Cardiac Electrophysiology, Aug 6, 2020
Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) exhibits an... more Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) exhibits anatomic variability and spatially heterogeneous propagation inside the Koch’s triangle (KT). The mechanism of the reentrant circuit has not been elucidated yet. Aim of this study is to describe the distribution of Jackman and Haïssaguerre potentials within the KT and to explore the activation mode of the KT, in sinus rhythm and during the slow-fast AVNRT. Forty-five consecutive cases of successful slow pathway (SP) ablation of typical slow-fast AVNRT from the CHARISMA registry were included. The KT geometry was obtained on the basis of the electroanatomic information using the Rhythmia mapping system (Boston Scientific) (mean number of points acquired inside the KT = 277 ± 47, mean mapping time = 11.9 ± 4 min). The postero-septal regions bounded anteriorly by the tricuspid annulus and posteriorly by the lateral wall toward the crista terminalis showed a higher prevalence of Jackman potentials than mid-postero-septal regions along the tendon of Todaro and coronary sinus (CS) (98% vs. 16%, p < 0.0001). Haïssaguerre potentials seemed to have a converse distribution across the KT (0% vs. 84%, p < 0.0001). Fast pathway insertion, as located during AVNRT, was mostly recorded in an antero-septal position (n = 36, 80%), rather than in a mid-septal (n = 6, 13.3%) or even postero-septal (n = 3, 7%) location. During typical slow-fast AVNRT, two types of propagation around the CS were discernible: anterior and posterior, n = 31 (69%), or only anterior, n = 14 (31%). During the first procedure, the SP was eliminated, and acute procedural success was achieved (median of 4 [3–5] RF ablations). High-density mapping of KT in AVNRT patients both during sinus rhythm and during tachycardia provides new electrophysiological insights. A better understanding and a more precise definition of the arrhythmogenic substrate in AVNRT patients may have prognostic value, especially in high-risk cases. Catheter Ablation of Arrhythmias With High Density Mapping System in the Real World Practice (CHARISMA) URL: http://clinicaltrials.gov/ Identifier: NCT03793998
Background Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) ... more Background Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) exhibits anatomic variability and spatially heterogeneous propagation inside the Kock's Triangle (KT). The mechanism of the reentrant circuit has not been elucidated yet. Purpose To evaluate signal characteristics and find out the origin, distribution, and timing of the slow pathway (SP) potentials recorded in the KT. Methods The 3-D KT geometry was created during both sinus rhythm (SR) and tachycardia (TR) from the basket mapping catheter IntellaMap Orion and the Rhythmia Mapping System (Boston Scientific). The KT was divided into 8 regions moving from an antero-septal to postero-septal areas and bounded by tricuspid annulus (TA) anteriorly and tendon of Todaro (TT) posteriorly. Each area was characterized in terms of distribution and timing of Jackman (JP) and Haissaguerre (HP) potentials and signal amplitude. Results 20 consecutive successful SP ablation cases of AVNRT were includ...
Journal of Interventional Cardiac Electrophysiology, 2022
Background Arrhythmic death is very common among patients with structural heart disease, and it i... more Background Arrhythmic death is very common among patients with structural heart disease, and it is estimated that in European countries, 1 per 1000 inhabitants yearly dies for sudden cardiac death (SCD), mainly as a result of ventricular arrhythmias (VA). The scar is the result of cardiac remodelling process that occurs in several cardiomyopathies, both ischemic and non-ischemic, and is considered the perfect substrate for re-entrant and non-re-entrant arrhythmias. Methods Our aim was to review published evidence on the histological and electrophysiological properties of myocardial scar and to review the central role of cardiac magnetic resonance (CMR) in assessing ventricular arrhythmias substrate and its potential implication in risk stratification of SCD. Results Scarring process affects both structural and electrical myocardial properties and paves the background for enhanced arrhythmogenicity. Non-uniform anisotropic conduction, gap junctions remodelling, source to sink mismatc...
Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve d... more Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavXguided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.
Backgrounds: Ablation procedures, cardiac surgeries, and extensive fibrosis may create the substr... more Backgrounds: Ablation procedures, cardiac surgeries, and extensive fibrosis may create the substrate of complex ATs. In these ATs, to predict the impact of ablation and the subsequent circuit of the second tachycardia is sometimes difficult. We aimed to elucidate the simple algorithm to predict the behavior of AT during radiofrequency application from the primary activation map of high-density mapping system. Methods: A simple algorithm for predicting termination/conversion of AT and the subsequent second AT circuit, associated with the ablation site, was developed from 71 index AT-activation map (retrospective phase) using high-density mapping system. The algorithm showed the sensitivity of 98.3% and the specificity of 83.3% to predict the termination/change of AT during ablation and the subsequent second AT circuit. This algorithm was subsequently tested prospectively in 188 consecutive ATs in 135 patients () (Prospective phase). Result: 13 focal ATs, 20 ATs without complete activation map, and 5 undiagnosed ATs with complete activation map was excluded from the study. Among 150 ATs, 115 ATs were predicted to be terminated, among which 5/115 (4.3%) was converted to another AT. Thirty-five ATs were predicted to be converted to another AT, among which 1/35 (2.9%) was terminated. The sensitivity and the specificity to predict termination/conversion of AT during ablation was 99.1% and 87.2% in total, 100% and 80.0% in macroreentrant AT, 100% and 90.9% in non-macroreentrant ATs, and 91.7% and 92.3% in deal-loop AT, respectively. Five ATs which were supposed to be terminated but to convert to the second ATs used the other atrral chamber or the epicardial structure in the second AT circuit. Conclusions: With the high-density mapping system, termination/conversion of the AT and the subsequent AT circuit was highly predictable from the index activation map.
Journal of Interventional Cardiac Electrophysiology, Jan 24, 2022
Background Arrhythmic death is very common among patients with structural heart disease, and it i... more Background Arrhythmic death is very common among patients with structural heart disease, and it is estimated that in European countries, 1 per 1000 inhabitants yearly dies for sudden cardiac death (SCD), mainly as a result of ventricular arrhythmias (VA). The scar is the result of cardiac remodelling process that occurs in several cardiomyopathies, both ischemic and non-ischemic, and is considered the perfect substrate for re-entrant and non-re-entrant arrhythmias. Methods Our aim was to review published evidence on the histological and electrophysiological properties of myocardial scar and to review the central role of cardiac magnetic resonance (CMR) in assessing ventricular arrhythmias substrate and its potential implication in risk stratification of SCD. Results Scarring process affects both structural and electrical myocardial properties and paves the background for enhanced arrhythmogenicity. Non-uniform anisotropic conduction, gap junctions remodelling, source to sink mismatch and refractoriness dispersion are some of the underlining mechanisms contributing to arrhythmic potential of the scar. All these mechanisms lead to the initiation and maintenance of VA. CMR has a crucial role in the evaluation of patients suffering from VA, as it is considered the gold standard imaging test for scar characterization. Mounting evidences support the use of CMR not only for the definition of gross scar features, as size, localization and transmurality, but also for the identification of possible conducting channels suitable of discrete ablation. Moreover, several studies call out the CMR-based scar characterization as a stratification tool useful in selecting patients at risk of SCD and amenable to implantable cardioverter-defibrillator (ICD) implantation. Conclusions Scar represents the substrate of ventricular arrhythmias. CMR, defining scar presence and its features, may be a useful tool for guiding ablation procedures and for identifying patients at risk of SCD amenable to ICD therapy.
Pacing and Clinical Electrophysiology, Jun 4, 2019
The mechanisms of AF induction and maintenance, including those involved in paroxysmal atrial fib... more The mechanisms of AF induction and maintenance, including those involved in paroxysmal atrial fibrillation, are not completely known; this limits our ablation strategies and prevents us from This article is protected by copyright. All rights reserved. 2 understanding what we are actually doing when performing pulmonary vein isolation. In this report, we focus on the commonly used ablation strategies for atrial fibrillation and question the importance of complete pulmonary vein isolation in achieving lasting success in the ablation of atrial fibrillation. We also discuss in detail the absence of durable pulmonary vein isolation in patients without arrhythmic recurrences after atrial fibrillation ablation and the possibility to cure paroxysmal atrial fibrillation without concomitant pulmonary vein isolation, provocatively questioning the dogma of pulmonary vein isolation as the cornerstone of atrial fibrillation ablation. Finally, a prospective personalized approach in the individual patient is advocated.
Despite the technical improvements made in recent years, the overall long-term success rate of ve... more Despite the technical improvements made in recent years, the overall long-term success rate of ventricular tachycardia (VT) ablation in patients with ischemic cardiomyopathy remains disappointing. This unsatisfactory situation has persisted even though several approaches to VT substrate ablation allow mapping and ablation of noninducible/nontolerated arrhythmias. The current substrate mapping methods present some shortcomings regarding the accurate definition of the true scar, the modality of detection in sinus rhythm of abnormal electrograms that identify sites of critical channels during VT and the possibility to determine the boundaries of functional re-entrant circuits during sinus or paced rhythms. In this review, we focus on current and proposed ablation strategies for VT to provide an overview of the potential/real application (and results) of several ablation approaches and future perspectives.
JPs seemed to have a converse distribution across the KTand they were mainly observed in the mid-... more JPs seemed to have a converse distribution across the KTand they were mainly observed in the mid-postero-septal region (73.3%). After 359±121 days of follow-up, no patients had a recurrence of AVNRT. Conclusion: The exact anatomical site and pathways involved in AVNRT are still unclear as well as the analysis and characterisation of the AVN potential. Our results represent the first evidence of the recording of AVN potential. Further studies and technological improvements are needed to confirm our results.
Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve d... more Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavXguided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.
Background: Activation mapping of Koch's Triangle, even when coupled with high density mapping, i... more Background: Activation mapping of Koch's Triangle, even when coupled with high density mapping, is incomplete without recordings of AV nodal electrical activity. Purpose: To identify, through a highly specific methodology and high-density electro-anatomical mapping (HDM), the slow AVN potential (AVNP) and the precise activation modality of Koch's Triangle in SR in atrio-ventricular nodal reentrant tachycardia (AVNRT) patients.
Backgrounds: Ablation procedures, cardiac surgeries, and extensive fibrosis may create the substr... more Backgrounds: Ablation procedures, cardiac surgeries, and extensive fibrosis may create the substrate of complex ATs. In these ATs, to predict the impact of ablation and the subsequent circuit of the second tachycardia is sometimes difficult. We aimed to elucidate the simple algorithm to predict the behavior of AT during radiofrequency application from the primary activation map of high-density mapping system. Methods: A simple algorithm for predicting termination/conversion of AT and the subsequent second AT circuit, associated with the ablation site, was developed from 71 index AT-activation map (retrospective phase) using high-density mapping system. The algorithm showed the sensitivity of 98.3% and the specificity of 83.3% to predict the termination/change of AT during ablation and the subsequent second AT circuit. This algorithm was subsequently tested prospectively in 188 consecutive ATs in 135 patients () (Prospective phase). Result: 13 focal ATs, 20 ATs without complete activation map, and 5 undiagnosed ATs with complete activation map was excluded from the study. Among 150 ATs, 115 ATs were predicted to be terminated, among which 5/115 (4.3%) was converted to another AT. Thirty-five ATs were predicted to be converted to another AT, among which 1/35 (2.9%) was terminated. The sensitivity and the specificity to predict termination/conversion of AT during ablation was 99.1% and 87.2% in total, 100% and 80.0% in macroreentrant AT, 100% and 90.9% in non-macroreentrant ATs, and 91.7% and 92.3% in deal-loop AT, respectively. Five ATs which were supposed to be terminated but to convert to the second ATs used the other atrral chamber or the epicardial structure in the second AT circuit. Conclusions: With the high-density mapping system, termination/conversion of the AT and the subsequent AT circuit was highly predictable from the index activation map.
Journal of Interventional Cardiac Electrophysiology, Aug 6, 2020
Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) exhibits an... more Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) exhibits anatomic variability and spatially heterogeneous propagation inside the Koch’s triangle (KT). The mechanism of the reentrant circuit has not been elucidated yet. Aim of this study is to describe the distribution of Jackman and Haïssaguerre potentials within the KT and to explore the activation mode of the KT, in sinus rhythm and during the slow-fast AVNRT. Forty-five consecutive cases of successful slow pathway (SP) ablation of typical slow-fast AVNRT from the CHARISMA registry were included. The KT geometry was obtained on the basis of the electroanatomic information using the Rhythmia mapping system (Boston Scientific) (mean number of points acquired inside the KT = 277 ± 47, mean mapping time = 11.9 ± 4 min). The postero-septal regions bounded anteriorly by the tricuspid annulus and posteriorly by the lateral wall toward the crista terminalis showed a higher prevalence of Jackman potentials than mid-postero-septal regions along the tendon of Todaro and coronary sinus (CS) (98% vs. 16%, p < 0.0001). Haïssaguerre potentials seemed to have a converse distribution across the KT (0% vs. 84%, p < 0.0001). Fast pathway insertion, as located during AVNRT, was mostly recorded in an antero-septal position (n = 36, 80%), rather than in a mid-septal (n = 6, 13.3%) or even postero-septal (n = 3, 7%) location. During typical slow-fast AVNRT, two types of propagation around the CS were discernible: anterior and posterior, n = 31 (69%), or only anterior, n = 14 (31%). During the first procedure, the SP was eliminated, and acute procedural success was achieved (median of 4 [3–5] RF ablations). High-density mapping of KT in AVNRT patients both during sinus rhythm and during tachycardia provides new electrophysiological insights. A better understanding and a more precise definition of the arrhythmogenic substrate in AVNRT patients may have prognostic value, especially in high-risk cases. Catheter Ablation of Arrhythmias With High Density Mapping System in the Real World Practice (CHARISMA) URL: http://clinicaltrials.gov/ Identifier: NCT03793998
Background Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) ... more Background Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) exhibits anatomic variability and spatially heterogeneous propagation inside the Kock's Triangle (KT). The mechanism of the reentrant circuit has not been elucidated yet. Purpose To evaluate signal characteristics and find out the origin, distribution, and timing of the slow pathway (SP) potentials recorded in the KT. Methods The 3-D KT geometry was created during both sinus rhythm (SR) and tachycardia (TR) from the basket mapping catheter IntellaMap Orion and the Rhythmia Mapping System (Boston Scientific). The KT was divided into 8 regions moving from an antero-septal to postero-septal areas and bounded by tricuspid annulus (TA) anteriorly and tendon of Todaro (TT) posteriorly. Each area was characterized in terms of distribution and timing of Jackman (JP) and Haissaguerre (HP) potentials and signal amplitude. Results 20 consecutive successful SP ablation cases of AVNRT were includ...
Journal of Interventional Cardiac Electrophysiology, 2022
Background Arrhythmic death is very common among patients with structural heart disease, and it i... more Background Arrhythmic death is very common among patients with structural heart disease, and it is estimated that in European countries, 1 per 1000 inhabitants yearly dies for sudden cardiac death (SCD), mainly as a result of ventricular arrhythmias (VA). The scar is the result of cardiac remodelling process that occurs in several cardiomyopathies, both ischemic and non-ischemic, and is considered the perfect substrate for re-entrant and non-re-entrant arrhythmias. Methods Our aim was to review published evidence on the histological and electrophysiological properties of myocardial scar and to review the central role of cardiac magnetic resonance (CMR) in assessing ventricular arrhythmias substrate and its potential implication in risk stratification of SCD. Results Scarring process affects both structural and electrical myocardial properties and paves the background for enhanced arrhythmogenicity. Non-uniform anisotropic conduction, gap junctions remodelling, source to sink mismatc...
Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve d... more Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavXguided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.
Backgrounds: Ablation procedures, cardiac surgeries, and extensive fibrosis may create the substr... more Backgrounds: Ablation procedures, cardiac surgeries, and extensive fibrosis may create the substrate of complex ATs. In these ATs, to predict the impact of ablation and the subsequent circuit of the second tachycardia is sometimes difficult. We aimed to elucidate the simple algorithm to predict the behavior of AT during radiofrequency application from the primary activation map of high-density mapping system. Methods: A simple algorithm for predicting termination/conversion of AT and the subsequent second AT circuit, associated with the ablation site, was developed from 71 index AT-activation map (retrospective phase) using high-density mapping system. The algorithm showed the sensitivity of 98.3% and the specificity of 83.3% to predict the termination/change of AT during ablation and the subsequent second AT circuit. This algorithm was subsequently tested prospectively in 188 consecutive ATs in 135 patients () (Prospective phase). Result: 13 focal ATs, 20 ATs without complete activation map, and 5 undiagnosed ATs with complete activation map was excluded from the study. Among 150 ATs, 115 ATs were predicted to be terminated, among which 5/115 (4.3%) was converted to another AT. Thirty-five ATs were predicted to be converted to another AT, among which 1/35 (2.9%) was terminated. The sensitivity and the specificity to predict termination/conversion of AT during ablation was 99.1% and 87.2% in total, 100% and 80.0% in macroreentrant AT, 100% and 90.9% in non-macroreentrant ATs, and 91.7% and 92.3% in deal-loop AT, respectively. Five ATs which were supposed to be terminated but to convert to the second ATs used the other atrral chamber or the epicardial structure in the second AT circuit. Conclusions: With the high-density mapping system, termination/conversion of the AT and the subsequent AT circuit was highly predictable from the index activation map.
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Papers by Marco Galeazzi