A Novel Approach for Localizing Non-Sustained Atrial Arrhythmias: Atrial Pace-Mapping With Automatic Intracardiac Pattern Matching.

Abstract

Introduction: Ventricular pace mapping is an established tool to identify the origin of non-inducible arrhythmias by analyzing the paced QRS morphology of the surface electrocardiogram (ECG). Using the same approach for atrial pace mapping (APM) was shown to be suboptimal, as accurate assessment of P wave morphology can be limited. We present a novel approach for APM using an automatic ECG pattern-matching algorithm with intracardiac unipolar signals (aICPM).

Methods and results: Forty-five consecutive patients presenting with non-sustained atrial tachycardia (nsAT) or non-pulmonary vein (PV) triggers were prospectively included. APM using aICPM was performed with six biatrial unipolar signals to create score maps. Ablation targeted sites with the best intracardiac pattern similarity. The primary endpoint was defined as successful localization and non-inducibility of the arrhythmia. Secondary endpoint was defined as freedom from AF/AT during the follow-up. APM with aICPM successfully identified specific areas with high intracardiac pattern similarity in all patients. The median time required to create a score map was 5.0 (IQR 3.3; 6.3) minutes, with 106 (IQR 77; 155) points per map. Radiofrequency ablation was performed successfully in all but two patients, with a median ablation time of 134 (IQR 75; 180) seconds and an ablation area of 2.0 (IQR 1.1; 2.3) cm². Two patients underwent ethanol ablation of the vein of Marshall. All cases achieved non-inducibility of the arrhythmia. During a follow-up of 5.9 ± 1.87 months, five patients experienced arrhythmia recurrence.

Conclusion: This novel approach rapidly and accurately identifies the origin of atrial arrhythmias by creating atrial pacemaps using an automated ECG pattern-matching algorithm, which processes intracardiac unipolar signals.