loading page

Characteristics of Macroreentries Using an Epicardial Bypass: Pseudo-Focal Atrial Tachycardia Case Series
  • +19
  • Yosuke Nakatani,
  • Takashi Nakashima ,
  • Josselin Duchateau,
  • Konstantinos Vlachos,
  • Philipp Krisai,
  • Takamitsu Takagi,
  • Tsukasa Kamakura,
  • Clémentine André,
  • Cyril Goujeau,
  • F. Daniel Ramirez,
  • Remi Chauvel,
  • Romain Tixier,
  • Masateru Takigawa,
  • Takeshi Kitamura,
  • Ghassen Cheniti,
  • Arnaud Denis,
  • Frederic Sacher,
  • Mélèze Hocini,
  • Michel Haissaguerre,
  • Pierre Jais,
  • Nicolas Derval,
  • Thomas Pambrun
Yosuke Nakatani
University of Toyama

Corresponding Author:[email protected]

Author Profile
Takashi Nakashima
1. Electrophysiology and Ablation Unit and L’Institut de rythmologie et modélisation cardiaque (LIRYC)
Author Profile
Josselin Duchateau
Centre Hospitalier Universitaire de Bordeaux
Author Profile
Konstantinos Vlachos
Evangelismos General Hospital of Athens
Author Profile
Philipp Krisai
University of Bordeaux
Author Profile
Takamitsu Takagi
Hôpital Cardiologique du Haut- Lévêque, CHU Bordeaux, L’Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux
Author Profile
Tsukasa Kamakura
National Cerebral and Cardiovascular Center
Author Profile
Clémentine André
CHU Trousseau
Author Profile
Cyril Goujeau
, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux)
Author Profile
F. Daniel Ramirez
Centre Hospitalier Universitaire de Bordeaux Hopital Cardiologique
Author Profile
Remi Chauvel
Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux)
Author Profile
Romain Tixier
Centre Hospitalier Universitaire de Bordeaux
Author Profile
Masateru Takigawa
Yokosuka Kyosai Hospital
Author Profile
Takeshi Kitamura
IHU LIRYC, University of Bordeaux, CHU de Bordeaux
Author Profile
Ghassen Cheniti
Hôpital Cardiologique du Haut Lévêque
Author Profile
Arnaud Denis
CHU Bordeaux
Author Profile
Frederic Sacher
Bordeaux University Hospital
Author Profile
Mélèze Hocini
Hôpital Cardiologique du Haut-Lévèque
Author Profile
Michel Haissaguerre
Hopital Cardiologique du Haut-Leveque
Author Profile
Pierre Jais
Centre Hospitalier Universitaire de Bordeaux
Author Profile
Nicolas Derval
Hopital cardiologique du haut-leveque
Author Profile
Thomas Pambrun
Hopital du Haut Leveque/LIRYC, Bordeaux
Author Profile

Abstract

Introduction: Human atria comprise distinct epicardial layers, which can bypass endocardial layers and lead to downstream centrifugal propagation at the “epi-endo” connection. We sought to characterize anatomical substrates, electrophysiological properties, and ablation outcomes of “pseudo-focal” atrial tachycardias (ATs), defined as macroreentrant ATs mimicking focal ATs. Methods and Results: We retrospectively analyzed ATs showing centrifugal propagation with post-pacing intervals (PPIs) after entrainment pacing suggestive of a macroreentry. A total of 26 patients had pseudo-focal ATs consisting of 15 perimitral, 7 roof-dependent, and 5 cavotricuspid isthmus (CTI)-dependent flutters. A low-voltage area was consistently found at the collision site and co-localized with epicardial layers like the: (1) coronary sinus-great cardiac vein bundle (22%); (2) vein of Marshall bundle (15%); (3) Bachmann bundle (22%); (4) septopulmonary bundle (15%); (5) fossa ovalis (7%); and (6) low right atrium (19%). The mean missing tachycardia cycle length (TCL) was 67 ± 29 ms (22%) on the endocardial activation map. PPI was 9 [0-15] ms and 10 [0-20] ms longer than TCL at the breakthrough site and the opposite site, respectively. While feasible in 25 pseudo-focal ATs (93%), termination was better achieved by blocking the anatomical isthmus than ablating the breakthrough site [24/26 (92%) vs. 1/6 (17%); p < 0.001]. Conclusion: Perimitral, roof-dependent, and CTI-dependent flutters with centrifugal propagation are favored by a low-voltage area located at well-identified epicardial bundles. Comprehensive entrainment pacing maneuvers are crucial to distinguish pseudo-focal ATs from true focal ATs. Blocking the anatomical isthmus is a better therapeutic option than ablating the breakthrough site.
04 Jun 2021Submitted to Journal of Cardiovascular Electrophysiology
14 Jun 2021Submission Checks Completed
14 Jun 2021Assigned to Editor
15 Jun 2021Reviewer(s) Assigned
22 Jun 2021Review(s) Completed, Editorial Evaluation Pending
28 Jun 2021Editorial Decision: Revise Minor
20 Jul 20211st Revision Received
20 Jul 2021Submission Checks Completed
20 Jul 2021Assigned to Editor
20 Jul 2021Reviewer(s) Assigned
20 Jul 2021Review(s) Completed, Editorial Evaluation Pending
21 Jul 2021Editorial Decision: Accept