Background
Reentrant circuits are considered to be critically dependent on a single protected
slow conducting isthmus.
Objective
The purpose of this study was to investigate conduction properties and electrogram
(EGM) characteristics of the entire circuit in localized atrial reentrant circuits
using high-resolution mapping.
Methods
Fifteen localized reentrant atrial tachycardias were studied with high-resolution
mapping (Rhythmia). EGMs along the entire circuit were analyzed offline for fractionation,
duration, and amplitude. Maps were exported to MATLAB (MathWorks) to measure bipolar
voltage and conduction velocities (CVs) within the circuit. Slow conduction was defined
as <30 cm/s.
Results
Fifteen localized re-entrant circuits (12 left atrial, 3 right atrial) with mean cycle
length 273 ± 40 ms were analyzed using high-resolution maps (22,389 ± 13,375 EGMs).
A mean of 4.5 ± 1.6 slow conduction corridors were identified per circuit. Although
the entire circuit was of low voltage, the bipolar voltage in slow conducting corridors
was significantly lower than the rest of the circuit (0.22 ± 0.20 mV vs 0.50 ± 0.48
mV; P <.001). The mean conduction velocity of the circuit, excluding slow conduction areas,
was 90.3 ± 34.3 cm/s vs 13.9 ± 3.5 cm/s (P <.001) in the slow conduction corridors. EGM analysis at the slowest conduction corridors
demonstrated fractionation (100%) with longer EGM duration compared to the other slow
conduction corridors along the circuit (99 ± 9 ms vs 74 ± 11 ms; P = .003).
Conclusion
In contrast to current understanding, localized atrial reentrant circuits have multiple
sequential “corridors” of very slow conduction (2–7) that contribute to maintenance
of arrhythmia. The localized reentry occurs in low-voltage areas, with voltage further
reduced in these multiple slow conducting corridors.
Keywords
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Article info
Publication history
Published online: November 27, 2018
Footnotes
Drs Jaïs, Derval, Sacher, and Frontera have received travel fees from Boston Scientific. Drs Jaïs and Sacher have received lecture fees.
Identification
Copyright
© 2018 Heart Rhythm Society. All rights reserved.
