Activation signature valleys are predictive of macroreentrant atrial tachycardia bottlenecks where uniform low voltage and uniform slow conduction reside

doi:10.1016/j.hrthm.2026.03.002

Arrhythmias & electrophysiologyResearch article

Activation signature valleys are predictive of macroreentrant atrial tachycardia bottlenecks where uniform low voltage and uniform slow conduction reside

Heart RhythmPublished 5 Mar 2026

Index cases with macroreentrant atrial tachycardia (AT)

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Authors' conclusion

The AS detects potential bottlenecks for predictive targeting in patients with AT, using differing criteria and often varying locationally from actual targeting, yet identifying areas with similarly uniform low voltage and uniform slow conduction. Predicted targets often coincide with voltage fissures, where sluggish conduction reinforces the excitable gap.

Study context

Population: Patients with macroreentrant atrial tachycardiaindex cases, plus 4 repeat ablations (44 procedures)
Participants: 40 patients

Comparison: Predicted and actual target parameter values were compared for voltage and electrical conduction vs peripheral (nontarget) sites.
Predicted targetn = 55

Main finding

As reported in the abstract

Number of predicted targets per procedure

Procedures with 1 predicted target

35

Procedures with 2 targets

7

Procedures with 3 targets

2

Total targets

N = 55

Further findings

Mean voltage

Peripheral (nontarget) sitesmean 0.71 ± 0.47 mV

Actual targetmean 0.29 ± 0.27 mV

Predicted targetmean 0.28 ± 0.21 mV

Voltage standard deviation

Peripheral (nontarget) sites1.14 ± 1.02 mV

Actual target0.20 ± 0.15 mV

Predicted target0.26 ± 0.22 mV

Outcome	Peripheral (nontarget) sites	Actual target	Predicted target
Coefficient of variation of the nearest-neighbor activation time difference (lower values indicative of uniform slow conduction)	1.99 ± 0.46 ms	1.50 ± 1.08 ms	0.73 ± 0.23 mV

Mean voltage: P < .001
Voltage standard deviation: P < .001
Coefficient of variation of the nearest-neighbor activation time difference (lower values indicative of uniform slow conduction): P < .001
Coefficient of variation of the nearest-neighbor activation time difference (lower values indicative of uniform slow conduction): unit printed as mV for the predicted target and ms for the other sites

Predicted target approximately overlapped the actual target

Procedures in which a predicted target approximately overlapped the actual target: 26 of 44

Original publication

Activation signature valleys are predictive of macroreentrant atrial tachycardia bottlenecks where uniform low voltage and uniform slow conduction reside. Heart Rhythm. Published 5 March 2026. doi:10.1016/j.hrthm.2026.03.002

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Summarised from the published abstract; every number is checked against it