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The isthmus characteristics of scar‐related macroreentrant atrial tachycardia in patients with and without cardiac surgery
Author(s) -
Liu ShinHuei,
Lin YennJiang,
Lee PoTseng,
Vicera Jennifer Jeanne,
Chang ShihLin,
Lo LiWei,
Hu YuFeng,
Chung FaPo,
Tuan TaChuan,
Chao TzeFan,
Liao JoNan,
Chang TingYung,
Lin ChinYu,
Wu ChengI,
Liu ChihMin,
Cheng WenHan,
Chen ShihAnn
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.15034
Subject(s) - medicine , ablation , cardiology , atrial tachycardia , tachycardia , catheter ablation , radiofrequency ablation , cardiac surgery , surgery
Identifying the critical isthmus (CI) in scar‐related macroreentrant atrial tachycardia (AT) is challenging, especially for patients with cardiac surgery. We aimed to investigate the electrophysiological characteristics of scar‐related macroreentrant ATs in patients with and without cardiac surgery. Methods A prospective study of 31 patients (mean age 59.4 ± 9.81 years old) with scar‐related macroreentrant ATs were enrolled for investigation of substrate properties. Patients were categorized into the nonsurgery ( n = 18) and surgery group ( n = 13). The CIs were defined by concealed entrainment, conduction velocity less than 0.3 m/s, and the presence of local fractionated electrograms. Results Among the 31 patients, a total of 65 reentrant circuits and 76 CIs were identified on the coherent map . The scar in the surgical group is larger than the nonsurgical group (18.81 ± 9.22 vs. 10.23 ± 5.34%, p = .016). The CIs in surgical group have longer CI length (15.27 ± 4.89 vs. 11.20 ± 2.96 mm, p = .004), slower conduction velocity (0.46 ± 0.19 vs. 0.69 ± 0.14 m/s, p < .001), and longer total activation time (45.34 ± 9.04 vs. 38.24 ± 8.41%, p = .016) than those in the nonsurgical group. After ablation, 93.54% of patients remained in sinus rhythm during a follow‐up of 182 ± 19 days. Conclusion The characteristics of the isthmus in macroreentrant AT are diverse, especially for surgical scar‐related AT. The identification of CIs can facilitate the successful ablation of scar‐related ATs.