Arrhythmias & electrophysiology

Detailed analysis of tachycardia cycle length aids diagnosis of the mechanism and location of atrial tachycardias

EuropacePublished Retrospective diagnostic study

Authors' conclusion

Detailed analysis of the tachycardia CL helps predict the AT-mechanism and the active AT chamber before an initial mapping.

Study context

Population
Atrial tachycardias with activation mapsAtrial tachycardia (AT) maps in 95 patients
Participants
138 participants
Comparison
Tachycardia cycle length (CL) features for predicting AT mechanism and chamber
  • focal-ATsn = 8reference
  • macroreentrant-ATsn = 94
  • localized-ATsn = 36
Outcome
Maximal CL (MCL) and minimal CL (mCL)

Performance

As reported in the abstract

Test or modelMaximal CL (MCL)Minimal CL (mCL)
focal-ATs506 (421-555)427 (347-508)
macroreentrant-ATs288 (253-348)283 (243-341)
localized-ATs314 (261-349)295 (248-340)

Maximal CL (MCL)

focal-ATs506 (421-555)
macroreentrant-ATs288 (253-348)
localized-ATs314 (261-349)

Minimal CL (mCL)

focal-ATs427 (347-508)
macroreentrant-ATs283 (243-341)
localized-ATs295 (248-340)
  • macroreentrant-ATs vs focal-ATs: P = 0.0001 — MCL
  • macroreentrant-ATs vs focal-ATs: P = 0.0012 — mCL
  • localized-ATs vs focal-ATs: P = 0.0016 — MCL
  • localized-ATs vs focal-ATs: P = 0.0047 — mCL

Further findings

Absolute CL-variation (MCL-mCL) < 24 ms for re-entrant vs focal ATs

Sensitivity
96.9%
Specificity
100%
PPV
100%
NPV
66.7%

Beat-by-beat CL-alternation

Observed, all re-entrant
10/138 (7.2%)
PPV for re-entrant mechanism
100%

CL-respiration correlation

Observed in ATs
28/138 (20.3%)
RA-ATs
24/41, 85.7%
LA-ATs
4/97, 4.1%
Positive correlation PPV for RA-ATs
85.7%
Negative correlation NPV for LA-ATs
84.5%

Original publication

Detailed analysis of tachycardia cycle length aids diagnosis of the mechanism and location of atrial tachycardias. Europace. Published 10 July 2023. doi:10.1093/europace/euad195

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