Purpose

Reentrant atrial tachycardias (ATs) use areas of slow conduction that can be visualized as fragmented electrograms. We aimed to test an ablation strategy based on the identification and ablation of spots with fragmented electrograms in reentrant ATs, using Rhythmia navigation system.

Methods

All consecutive patients from June 2016 to June 2019 were included. The IntellaMap ORION Catheter was used to detect sites with fragmentation, arbitrarily defined as fragmented electrograms > 70 ms. Entrainment was used to check if these areas belonged to the AT circuit. Ablation targeted the longest fragmented electrogram within the circuit: focal ablation for microreentries and lines for macroreentries. Ablation success was defined from each AT as conversion to sinus rhythm or another AT.

Results

Twenty-seven consecutive patients with 44 mappable ATs were included. All ATs showed sites with fragmented electrograms (104 sites; 2.4 sites per AT); 43/44 ATs had fragmented electrograms within the circuit, which were the target of ablation. Ablation success: 34/36 ATs (94%); success could not be assessed in 8 circuits, in 6 due to mechanical conversion to sinus rhythm at the target fragmented site. Fragmented electrograms within the AT circuits were longer than electrograms outside the circuits (110 ± 30 vs 90 ± 15 ms, p < 0.001). A fragmentation duration > 100 ms/ > 40% of the AT cycle length predicted to be a successful site for ablation with 72.3%/73.8% specificity, respectively. Sixty-two percent of the patients were free from atrial arrhythmias at 1 year.

Conclusions

Most ATs had detectable fragmented electrograms within the circuit, which could be the target of ablation with high efficacy.

中文翻译：

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折返性房性心动过速患者的高密度标测和碎片分析（MAP-FLURHY 研究）

目的

折返性房性心动过速 (ATs) 使用的传导缓慢的区域可以显示为碎片电图。我们的目标是使用 Rhythmia 导航系统，基于识别和消融可重入 AT 中具有碎片电图的斑点来测试消融策略。

方法

纳入 2016 年 6 月至 2019 年 6 月的所有连续患者。IntellaMap ORION 导管用于检测有碎片的部位，任意定义为碎片电图 > 70 ms。夹带用于检查这些区域是否属于 AT 电路。消融针对电路中最长的碎片电图：微再入的焦点消融和宏观再入的线。每个 AT 的消融成功定义为转换为窦性心律或另一个 AT。

结果

包括 27 名具有 44 个可映射 ATs 的连续患者。所有 AT 均显示电图碎片化的部位（104 个部位；每个 AT 2.4 个部位）；43/44 ATs 在电路内有碎片电图，这是消融的目标。消融成功：34/36 ATs (94%)；由于在目标碎片部位机械转换为窦性心律，8 个电路无法评估成功。AT 电路内的碎片电图比电路外的电图更长（110 ± 30 vs 90 ± 15 ms，p < 0.001）。碎片持续时间 > 100 毫秒/ > 40% 的 AT 循环长度预计是成功的消融位点，特异性分别为 72.3%/73.8%。62% 的患者在 1 年时无房性心律失常。

结论

大多数 AT 在电路内都有可检测到的碎片电图，这可能是高效消融的目标。