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Comparison of single premature versus continuous overdrive stimulation for identification of a protected isthmus in macro-reentrant atrial tachycardia circuits

      The demonstration of tachycardia entrainment with concealed fusion in response to continuous overdrive atrial pacing (OAP) during atrial macro-reentry is helpful to identify an isthmus of “protected” conduction (i.e., that bounded by fixed or functional lines of conduction block) within the reentry circuit and to guide the radiofrequency current delivery during catheter ablation procedures.
      • Stevenson W.G.
      • Sager P.T.
      • Friedman P.L.
      Entrainment techniques for mapping atrial and ventricular tachycardias.
      ,
      • Kalman J.M.
      • VanHare G.F.
      • Olgin J.E.
      • Saxon L.A.
      • Stark S.I.
      • Lesh M.D.
      Ablation of “incisional” reentrant tachycardia complicating surgery for congenital heart disease. Use of entrainment to define a critical isthmus of conduction.
      ,
      • Kalman J.M.
      • Olgin J.F.
      • Saxon L.A.
      • Lee R.M.
      • Scheinman M.M.
      • Lesh M.D.
      Electrocardiographic and electrophysiologic characterization of atypical atrial flutter in man use of activation and entrainment mapping and implications for catheter ablation.
      However, entrainment mapping may result in inadvertent termination of the tachycardia or transformation into nonclinical arrhythmias by overdrive stimulation. Therefore, its extensive application during catheter ablation procedures is sometimes discouraged,
      • Shah D.
      • Jais P.
      • Takahashi A.
      • Hocini M.
      • Peng J.T.
      • Clementy J.
      • Haissaguerre M.
      Dual-loop intra-atrial reentry in humans.
      ,
      • Jais P.
      • Shah D.C.
      • Haissaguerre M.
      • Hocini M.
      • Peng J.T.
      • Takahashi A.
      • Garrigue S.
      • Le Metayer P.
      • Clementy J.
      Mapping and ablation of left atrial flutters.
      ,
      • Nakagawa H.
      • Shah N.
      • Matsudaira K.
      • Overholt E.
      • Chandrasekaran K.
      • Beckman K.J.
      • Spector P.
      • Calame J.D.
      • Rao A.
      • Hasdemir C.
      • et al.
      Characterization of reentrant circuits in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease. Isolated channels between scars allow “focal” ablation.
      and alternative pacing techniques may be requested. In the present report, we have prospectively evaluated the feasibility and usefulness of single premature atrial beat (SPAB) stimulation compared with standard OAP in identifying the isthmus of protected conduction during different macro-reentrant atrial tachycardias.
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