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Low-Voltage Areas as Alternative Targetsfor the Ablation of unmappable Atrial Tachycardiain Patients Undergoing Atrial Fibrillation Ablation

Aims: Unmappable regular atrial tachycarrhythmias (ATs) occasionally develop during atrial fibrillation (AF) ablation, and are difficult to treat by conventional ablation. Recently, low-voltage areas (LVAs) have been reported to representAT substrate. The purpose of this study was to elucidate the efficacy of LVA ablation for unmappable AT. Methods: This observational study included 32 consecutive patients who developed unmappable ATs during and after AF ablation. Unmappable AT was defined as AT lasting for >5 s, but that terminated or changed the activation sequence over too short a time to create a sufficient activation map.We used conventional ablation totarget undetermined AT circuits estimated from activation timings of electrograms recorded on the placed electrode catheter, the response to entrainment mappings, and/or diastolic potentials during AT. Subsequently, in cases without successful elimination of unmappable ATs by conventional ablation,LVA (≤ 0.5mV)ablation was performed at the discretion of the operators. Results:Conventional ablation failed to eliminate at least one unmappable AT in 29 patients. Among them, LVA ablation was performed in 16 patients. LVA ablation eliminated all the unmappable ATs in 8 of 16patients. The LVA size did not differ between patients with and without the acute elimination of unmappable ATs (17±11 vs. 21±12 cm2, p=0.39), and AT/AF recurrence rates were comparable between the two groups (38% vs. 63%, p=0.62)during a mean follow-up period of 14±8 months.

Credits: Masaharu Masuda, MD, PhD;MitsutoshiAsai, MD, PhD;Osamu Iida, MD;Shin Okamoto, MD;Takayuki Ishihara, MD;Kiyonori Nanto, MD; Takashi Kanda, MD;Takuya Tsujimura, MD; Yasuhiro Matsuda, MD;Shota Okuno, MD;MD; Toshiaki Mano, MD, PhD

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