Outcomes of catheter ablation of atrial tachyarrhythmia guided exclusively by activation mapping

Xiaodong Zhang, Weijia Li, Aung Lin, Fengwei Zou, Jacopo Marazzato, Dimitrios Varrias, Sanjana Nagraj, Yu Chiang Wang, Jiyoung Seo, Domenico G. Della Rocca, Emma Levine, Pasquale Santangeli, Dhanunjaya Lakkireddy, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Introduction: Complex atrial tachyarrhythmias (CATs) are commonly observed in patients with prior catheter ablation or cardiac surgery. These arrhythmias are challenging to map and ablate. Historically, entrainment mapping was utilized to characterize CAT. With the advent of high-definition mapping (HDM), full visualization of the CAT circuit is possible which may obviate the need for entrainment mapping. Methods: We sought to investigate the outcomes of catheter ablation of CAT guided only by HDM. Consecutive patients who underwent CAT ablation from 2017 to 2021 were included in our study (excluding right atrial tachyarrhythmias). Patients were sorted by the type of mapping performed. Group I consisted of patients where HDM alone was utilized with no attempt of entrainment. Group II consisted of patients where both entrainment and HDM were utilized. Results: A total of 67 patients were included in our study, with 40 patients in HDM group (I) and 27 patients in entrainment group (II). No statistically significant difference regarding 1-year freedom from atrial arrhythmias was found between the two groups (80% vs 77.8%, p = 0.819). Four CATs were terminated by entrainment during procedure versus none in the HDM-only group (p = 0.011). Conclusions: CAT ablation with HDM alone yielded similar 1-year freedom from atrial arrhythmias compared to ablation with HDM and entrainment. Entrainment combined with HDM was associated with higher undesired CAT interruption rate. Further validation is needed with randomized control trials.

Original languageEnglish (US)
Pages (from-to)1383-1389
Number of pages7
JournalJournal of Interventional Cardiac Electrophysiology
Issue number6
StatePublished - Sep 2023


  • Catheter ablation
  • Complex atrial tachyarrhythmias
  • Entrainment
  • High-definition mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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