An improved window of interest for electroanatomical mapping of atrial tachycardia

Abstract

Abstract Purpose Diagnosis of atrial tachycardia (AT) with 3D mapping system remains challenging due to fibrosis or previous ablation. This study aims to evaluate a new electroanatomical mapping annotation setting using a window of interest adjusted at the end of the P wave (WOIp wave) to identify the AT mechanism more accurately. Methods Twenty patients with successful ablation of left AT using navigation system CARTO3 were evaluated. Two maps for each patient were generated offline using either conventional settings of WOI (WOIconv.) or WOIp wave. Three investigators from two centres analysed the maps blindly. Results Mechanisms of AT were macroreentrant in 14/20 patients (70%) and focal in 6/20 (30%). WOIp wave resulted in a significant increase in the percentage of correct identification of the mechanism based on mapping alone (93.3 ± 13.7% vs 58.3 ± 33.9%; p = 0.0003) compared with WOIconv.. Diagnoses based on mapping were arrived at faster (27.8 ± 16.4 s vs 38.97 ± 13.64 s, respectively; p = 0.0231) and with a greater confidence in the diagnosis (confidence index 2.57 ± 0.45 vs 2.12 ± 0.45, respectively; p = 0.0024). With perimitral re-entry specifically “early meets late” was closer to the anatomical region of the mitral isthmus (15.9 ± 20.9 mm vs 48.77 ± 23.23 mm, respectively; p = 0.0028). Conclusions This study found that electroanatomical mapping acquisition with a window of interest set at the end of the P wave improves the ability to diagnose the arrhythmia mechanism based on the initial map. It is particularly beneficial in identifying area of interest for ablation in perimitral AT.