Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May;35(5):950-964.
doi: 10.1111/jce.16221. Epub 2024 Mar 13.

Peak frequency mapping of atypical atrial flutter

Maham F Karatela  1   2 , Robert S Dowell  1   3 , Daniel J Friedman  1   2 , Kevin P Jackson  1 , Kevin L Thomas  1   2 , Jonathan P Piccini  1   2
Affiliations

Peak frequency mapping of atypical atrial flutter

Maham F Karatela et al. J Cardiovasc Electrophysiol. 2024 May.

Abstract

Introduction: Peak frequency (PF) mapping is a novel method that may identify critical portions of myocardial substrate supporting reentry. The aim of this study was to describe and evaluate PF mapping combined with omnipolar voltage mapping in the identification of critical isthmuses of left atrial (LA) atypical flutters.

Methods and results: LA omnipolar voltage and PF maps were generated in flutter using the Advisor HD-Grid catheter (Abbott) and EnSite Precision Mapping System (Abbott) in 12 patients. Normal voltage was defined as ≥0.5 mV, low-voltage as 0.1-0.5 mV, and scar as <0.1 mV. PF distributions were compared with ANOVA and post hoc Tukey analyses. The 1 cm radius from arrhythmia termination was compared to global myocardium with unpaired t-testing. The mean age was 65.8 ± 9.7 years and 50% of patients were female. Overall, 34 312 points were analyzed. Atypical flutters most frequently involved the mitral isthmus (58%) or anterior wall (25%). Mean PF varied significantly by myocardial voltage: normal (335.5 ± 115.0 Hz), low (274.6 ± 144.0 Hz), and scar (71.6 ± 140.5 Hz) (p < .0001 for all pairwise comparisons). All termination sites resided in low-voltage regions containing intermediate or high PF. Overall, mean voltage in the 1 cm radius from termination was significantly lower than the remaining myocardium (0.58 vs. 0.95 mV, p < .0001) and PF was significantly higher (326.4 vs. 245.1 Hz, p < .0001).

Conclusion: Low-voltage, high-PF areas may be critical targets during catheter ablation of atypical atrial flutter.

Keywords: atypical atrial flutter; cardiac mapping; catheter ablation; electroanatomic mapping; signal processing.

PubMed Disclaimer

References

REFERENCES

    1. Bun SS, Latcu DG, Marchlinski F, Saoudi N. Atrial flutter: more than just one of a kind. Eur Heart J. 2015;36:2356‐2363.
    1. Chae S, Oral H, Good E, et al. Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation. J Am Coll Cardiol. 2007;50:1781‐1787.
    1. Derval N, Takigawa M, Frontera A, et al. Characterization of complex atrial tachycardia in patients with previous atrial interventions using high‐resolution mapping. JACC: Clin Electrophysiol. 2020;6:815‐826.
    1. Jaïs P, Shah DC, Haïssaguerre M, et al. Mapping and ablation of left atrial flutters. Circulation. 2000;101:2928‐2934.
    1. Coffey JO, d'Avila A, Dukkipati S, et al. Catheter ablation of scar‐related atypical atrial flutter. EP Europace. 2013;15:414‐419.

Publication types

LinkOut - more resources