Article Dans Une Revue JACC: Clinical Electrophysiology Année : 2025

High-Resolution Mapping vs Differential Pacing in Evaluating Atrial Linear Lesions and the Impact of Pseudoblocks on AT Risk

Konstantinos Vlachos
  • Fonction : Auteur
Karim Benali
  • Fonction : Auteur
Nicolas Derval
  • Fonction : Auteur
Thomas Pambrun
  • Fonction : Auteur
Antonio Frontera
  • Fonction : Auteur
Masaaki Yokoyama
  • Fonction : Auteur
Kinan Kneizeh
  • Fonction : Auteur
Ciro Ascione
  • Fonction : Auteur
Cinzia Monaco
  • Fonction : Auteur
Christopher Kowalewski
  • Fonction : Auteur
Roberto Mene
  • Fonction : Auteur
Stylianos Tzeis
  • Fonction : Auteur
Panagiotis Vardas
  • Fonction : Auteur
Dimitrios Asvestas
  • Fonction : Auteur
Aline Carapezzi
  • Fonction : Auteur
Jean-Rodolphe Roux
  • Fonction : Auteur
Romain Tixier
  • Fonction : Auteur
Remi Chauvel
  • Fonction : Auteur
Marine Arnaud
  • Fonction : Auteur
Benjamin Sacristan
  • Fonction : Auteur
Hubert Cochet
  • Fonction : Auteur
Josselin Duchateau
  • Fonction : Auteur
Frederic Sacher
  • Fonction : Auteur
Meleze Hocini
  • Fonction : Auteur
Antoine da Costa
  • Fonction : Auteur
Michel Haissaguerre
  • Fonction : Auteur
Pierre Jais
  • Fonction : Auteur

Résumé

BACKGROUND: Although differential pacing (DP) has been conventionally used to confirm the achievement of block across linear lesion sets, high-resolution mapping (HRM)can unmask pseudoblock and persistent residual conduction across the lines. OBJECTIVES: This study aimed to compare conventional DP criteria with HRM for line assessment and to evaluate the impact of persistent residual conduction across a line on the risk of developing atrial tachycardia (AT) during follow-up. METHODS: Our study included consecutive patients who underwent AT or persistent atrial fibrillation ablation with ≥1 atrial linear lesion. We systematically evaluated the existence of a residual conduction through all linear lesions using HRM and compared this strategy with the results of DP. RESULTS: In a cohort of 102 patients, 101 cavotricuspid isthmus lines, 85 roof lines, and 84 mitral isthmus lines were systematically evaluated using DP and HRM. Among the cavotricuspid isthmus lines, 38 lines (37.6%) exhibited residual conduction as determined by HRM. In these 38 cases, DP yielded a false-positive result in 14 cases (37%). For the roof lines, 40 lines (47.1%) showed residual conduction, with DP yielding false-positive results in 16 (40%) of these cases. Regarding the mitral isthmus lines, 24 lines (28.6%) displayed residual conduction, and DP provided false-positive results in 13 (54%) of these cases. The 1-year AT-free survival rate was 95.4% in patients where all attempted lines were successfully blocked, compared to 31.9% in those with ≥1 line that remained unblocked despite multiple ablation attempts. CONCLUSIONS: The systematic use of HRM for line assessment allows to unmask a substantial proportion of pseudoblocks not identified by DP. The existence of a persistent residual conduction through a line is associated with a high risk of AT during follow-up.

Fichier non déposé

Dates et versions

hal-05084069 , version 1 (26-05-2025)

Identifiants

Citer

Konstantinos Vlachos, Karim Benali, Nicolas Derval, Thomas Pambrun, Antonio Frontera, et al.. High-Resolution Mapping vs Differential Pacing in Evaluating Atrial Linear Lesions and the Impact of Pseudoblocks on AT Risk. JACC: Clinical Electrophysiology, 2025, ⟨10.1016/j.jacep.2025.02.042⟩. ⟨hal-05084069⟩
28 Consultations
0 Téléchargements

Altmetric

Partager

  • More