New imaging and computational technology as a guide for catheter ablation of incessant tachyarrhythmias

Computational technology in the era of catheter ablation (RFA) has made it possible to experience relief from incessant atrial tachyarrhythmias (AT) by 3D electroanatomical mapping (EAM) systems. The Authors report the results of such technology in > 500 consecutive patients (57% males, mean age 56.9 years) with incessant refractory post-ablation left AT (mean cycle length 256 ms). Patients underwent electroanatomical-mapping systems, which combine electrophysiological and spatial information allowing accurate reconstruction of the whole atria with real-time activation sequence guiding RFA for continuous transmural linear lesions. Color-coded voltage and/or activation maps were successfully performed in all patients. Mapping distinguished clearly and rapidly between micro-macro-reentrant (>80%) and focal mechanisms. Acute success was obtained without major complications, with repeated procedures in about 5% of patients. EAM technology allows determining both mechanism and location of arrhythmia, ensuring successful elimination of complex arrhythmogenic substrates.