Disclosures:
Dr. Rodrigo reports no disclosures. Dr. Narayan reports consulting fees
from Beyond.ai Inc, TDK Inc., Up to Date, Abbott Laboratories, and
American College of Cardiology Foundation (all modest); Intellectual
Property Rights from University of California Regents and Stanford
University.
The mapping and ablation of Atrial Tachycardias (AT) can be challenging,
particularly in patients with prior ablation or structural atrial
disease. Entrainment is the foundation to confirm anatomically-based
reentry but, in patients with structural disease, may transform or
terminate AT. Activation mapping is thus often used in parallel. In
recent years, high resolution catheters have increasingly been used to
reveal micro-reentry at sites that appeared focal1, to
improve definition of gaps in scar or ablation lines2and to improve mechanistic definition3. In principle,
it should be straightforward to use electroanatomical systems to mark
electrograms and create isochrones for stable AT to guide ablation. In
practice, it can be difficult to mark activation in electrograms that
are fractionated or have low amplitude, which are common at sites of
scar or prior ablation where AT often arise. It can thus be difficult to
determine which activation sequence best represents arrhythmia and
should be targeted for ablation. This remains a major clinical
challenge, and there is a real need for objective tools to improve this
interpretative process.