Principles and Techniques of the Three-Dimensional Electroanatomic Cardiac Mapping Approach in the Treatment of Intractable Atrial Macroreentrant Tachycardia Ablations

Abstract

Introduction: Challenging and intractable macroreentrant atrial tachycardias mostly occur after cardiac surgeries, and the response of such arrhythmias to conventional treatments is poor. Also, arrhytmias with previous unsuccessful ablations are compulsive arrhytmias. This study represents our approach for the ablation of challenging atrial macroreentrant tachycardias. Patients and Methods: Five consecutive patients with atrial þutter and a previous history of cardiac surgery and/or radiofrequency ablation were enrolled to this study. The focal point of the clinical arrhythmia was deÞned in the CARTO® and Columbus™ map and the critical isthmus was targeted for ablation. Radiofrequency ablation was performed until the arrhythmia stopped or until a change in cycle length or activation wave front was seen. Results: All the complex atrial macroreentrant tachycardias were arized from the right atrium. Overall, all the cases were successfully mapped and ablated. None of the patients had recurrence even after 6 months of follow-up. The mean (±SD) procedure time was 49.0 ± 22.4 min. Three-dimensional electroanatomic cardiac mapping technologies, including CARTO and Columbus™, are highly effective in revealing atrial arrhytmias and facilitating ablation of the scar-related potential circuits. Conclusion: This study highlights success and usefulness of three-dimensional electroanatomic cardiac mapping in complex atrial macroreentrant tachycardia ablations.