Detailed analysis of tachycardia cycle length aids diagnosis of the mechanism and location of atrial tachycardias

Masateru Takigawa; Tsukasa Kamakura; Claire Martin; Nicolas Derval; Ghassen Cheniti; Josselin Duchateau; Thomas Pambrun; Frederic Sacher; Hubert Cochet; Meleze Hocini; Miho Negishi; Tasuku Yamamoto; Takashi Ikenouchi; Kentaro Goto; Takatoshi Shigeta; Takuro Nishimura; Susumu Tao; Shinsuke Miyazaki; Masahiko Goya; Tetsuo Sasano; Michel Haissaguierre; Pierre Jais

doi:10.1093/europace/euad195

Detailed analysis of tachycardia cycle length aids diagnosis of the mechanism and location of atrial tachycardias

Europace. 2023 Aug 2;25(9):euad195. doi: 10.1093/europace/euad195.

Authors

Masateru Takigawa^{1

2

3

4}, Tsukasa Kamakura^{1

2}, Claire Martin^{1

5

6}, Nicolas Derval^{1

2}, Ghassen Cheniti^{1

2}, Josselin Duchateau^{1

2}, Thomas Pambrun^{1

2}, Frederic Sacher^{1

2}, Hubert Cochet², Meleze Hocini^{1

2}, Miho Negishi³, Tasuku Yamamoto³, Takashi Ikenouchi³, Kentaro Goto³, Takatoshi Shigeta³, Takuro Nishimura³, Susumu Tao³, Shinsuke Miyazaki^{3

4}, Masahiko Goya¹, Tetsuo Sasano³, Michel Haissaguierre^{1

2}, Pierre Jais^{1

2}

Affiliations

¹ Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), Av. Magellan, 33600 Pessac, France.
² IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, Av. du Haut Lévêque, 33600 Pessac, France.
³ Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo.
⁴ Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8510, Tokyo.
⁵ Cardiology Department, Royal Papworth Hospital, Cambridge CB2 0AY, UK.
⁶ Department of Medicine, Cambridge University, Cambridge CB2 0QQ, UK.

Abstract

Aims: Although the mechanism of an atrial tachycardia (AT) can usually be elucidated using modern high-resolution mapping systems, it would be helpful if the AT mechanism and circuit could be predicted before initiating mapping.

Objective: We examined if the information gathered from the cycle length (CL) of the tachycardia can help predict the AT-mechanism and its localization.

Methods: One hundred and thirty-eight activation maps of ATs including eight focal-ATs, 94 macroreentrant-ATs, and 36 localized-ATs in 95 patients were retrospectively reviewed. Maximal CL (MCL) and minimal CL (mCL) over a minute period were measured via a decapolar catheter in the coronary sinus. CL-variation and beat-by-beat CL-alternation were examined. Additionally, the CL-respiration correlation was analysed by the RhythmiaTM system. : Both MCL and mCL were significantly shorter in macroreentrant-ATs [MCL = 288 (253-348) ms, P = 0.0001; mCL = 283 (243-341) ms, P = 0.0012], and also shorter in localized-ATs [MCL = 314 (261-349) ms, P = 0.0016; mCL = 295 (248-340) ms, P = 0.0047] compared to focal-ATs [MCL = 506 (421-555) ms, mCL = 427 (347-508) ms]. An absolute CL-variation (MCL-mCL) < 24 ms significantly differentiated re-entrant ATs from focal-ATs with a sensitivity = 96.9%, specificity = 100%, positive predictive value (PPV) = 100%, and negative predictive value (NPV) = 66.7%. The beat-by-beat CL-alternation was observed in 10/138 (7.2%), all of which showed the re-entrant mechanism, meaning that beat-by-beat CL-alternation was the strong sign of re-entrant mechanism (PPV = 100%). Although the CL-respiration correlation was observed in 28/138 (20.3%) of ATs, this was predominantly in right-atrium (RA)-ATs (24/41, 85.7%), rather than left atrium (LA)-ATs (4/97, 4.1%). A positive CL-respiration correlation highly predicted RA-ATs (PPV = 85.7%), and negative CL-respiration correlation probably suggested LA-ATs (NPV = 84.5%).

Conclusion: Detailed analysis of the tachycardia CL helps predict the AT-mechanism and the active AT chamber before an initial mapping.

Keywords: Activation; Atrial tachycardia; Catheter ablation; Cycle length; High-resolution; Mapping.

MeSH terms

Catheter Ablation*
Electrophysiologic Techniques, Cardiac
Heart Atria
Humans
Retrospective Studies
Tachycardia
Tachycardia, Supraventricular*
Treatment Outcome