Insights into the mechanism of atrial tachycardia with over two types of
reentrant circuits: the important role of the convertibility of
functional conduction block regions in maintaining multiple reentrant
circuit pathways
Abstract
Background: Multiple atrial tachycardias (ATs) in one patient usually
require more complex ablation procedures. Despite the superior accuracy
and understanding of conduction features provided by high-resolution
mapping, Multiple ATs are still associated with high recurrence rates,
and other mechanisms may play a role. Therefore, we aimed to uncover the
substrates maintaining these multiple reentrant circuits and the
probable mechanisms for the high occurrence of arrhythmia. Methods:
Mapping via the Carto system was carried out in 8 patients with more
than two types of reentrant circuits during ablation. Functional
conduction block (FCB) regions were marked and further analyzed.
Results: Twenty sustained ATs were mapped in the 8 patients. Five of
these patients exhibited a potential FCB region that changed between
different ATs. The potentials of these regions converted between double
potentials (DPs), fractionated potentials (FPs) and normal potential due
to the different ATs. The FCB regions were the main obstacles and the
center of the reentrant circuit in 8 of 14 ATs, and in the other ATs,
these regions played a role in reorganizing the conduction pathway. In
the activation mapping, the FCB areas were never the target ablation
site. Conclusion: The potential FCB region is common in ATs with more
than two types of reentrant circuits, especially in scar-related
localized reentry. The convertibility of FCB regions provide one of the
critical substrates in maintaining multiple ATs. The changefulness of
this substrate may be one of the important causes of the high recurrence
of related ATs