Arrhythmias & electrophysiology
First Clinical Experience With Reversible Electroporation Mapping in Atrial Flutter
Authors' conclusion
PF REV mapping is a novel, feasible, and reproducible tool for identifying critical sites in reentrant atrial tachycardia with narrow isthmuses that may be improved through optimized triggering and dose titration.
Study context
- Population
- Patients with reentrant atrial tachycardias (atrial flutter); PF REV pulses delivered in and outside of the circuit using a 9-mm lattice-tip catheter30 reentrant atrial tachycardias in 26 patients, 163 PF REV pulses analyzed
- Participants
- 26 patients
- Comparison
- Propagated versus Nonpropagated PF REV cohorts
- Propagated PF REVn = 56
- Outcome
- Atrial capture and propagation
Main finding
As reported in the abstract
PF REV pulses showing atrial capture and propagation, out of 163
56
34.4%
Further findings
Coupling interval · significantly longer with propagated
P < 0.001
Irregular TCL variations
P = 0.002
Responses to PF REV pulses (globally)
- Tachycardia termination
- 11.0%
- Stable tachycardia cycle length (TCL) prolongation
- 9.8%
- Transient irregular TCL variations
- 3.1%
- No change in activation sequence and TCL
- 76.1%
Specificity for localizing reentry circuit and critical isthmus
- Termination or TCL prolongation only when delivered in the reentry circuit (specificity)
- 100%
- Termination exclusively in the critical isthmus (specificity regardless of propagation)
- 100%
- Stable TCL prolongation in the isthmus
- 93.8%
- Stable TCL prolongation in the outer loop
- 6.2%
- Specificity for nonpropagated PF REV to localize the isthmus
- 100%
- Specificity for propagated PF REV to localize the isthmus
- 83.3%
Sensitivity of termination or stable TCL prolongation for identifying the critical isthmus
- Sensitivity (moderate)
- 38.8%
- Isthmus width
- 11.7±1.7 mm versus 22.9±2.1 mm
- Influenced by isthmus width, P <0.001
Reproducibility of PF REV pulses
- Reproducibility (high)
- 82.9%
Original publication
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