Imperial College London
Dr Vias Markides

DrViasMarkides

Faculty of Medicine, National Heart & Lung Institute

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 7351 8619v.markides

 
 
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Assistant

 

Dr Tom Wong +44 (0)20 7351 8619

 
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Location

 

Chelsea WingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Mantziari:2019:10.1161/JAHA.118.010535,
author = {Mantziari, L and Butcher, C and Shi, R and Kontogeorgis, A and Opel, A and Chen, Z and Haldar, S and Panikker, S and Hussain, W and Jones, DG and Gatzoulis, MA and Markides, V and Ernst, S and Wong, T},
doi = {10.1161/JAHA.118.010535},
journal = {Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease},
title = {Characterization of the mechanism and substrate of atrial tachycardia using ultra-high-density mapping in adults with congenital heart disease: Impact on clinical outcomes},
url = {http://dx.doi.org/10.1161/JAHA.118.010535},
volume = {8},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundAtrial tachycardia (AT) is common in patients with adult congenital heart disease and is challenging to map and ablate. We used ultrahighdensity mapping to characterize the AT mechanism and investigate whether substrate characteristics are related to ablation outcomes.Methods and ResultsA total of 50 ATs were mapped with ultrahighdensity mapping in 23 procedures. Patients were followed up for up to 12 months. Procedures were classified to group A if there was 1 single AT induced (n=12) and group B if there were ≥2 ATs induced (n=11 procedures). AT mechanism per procedure was macro reentry (n=10) and localized reentry (n=2) in group A and multiple focal (n=6) or multiple macro reentry (n=5) in group B. Procedure duration, low voltage area (0.05–0.5 mV), and low voltage area indexed for volume were higher in group B (159 [147–180] versus 412 [352–420] minutes, P<0.001, 22.6 [12.2–29.8] versus 54.2 [51.1–61.6] cm2, P=0.014 and 0.17 [0.12–0.21] versus 0.26 [0.23–0.27] cm2/mL, P=0.024 accordingly). Dense scar (<0.05 mV) and atrial volume were similar between groups. Acute success and freedom from arrhythmia recurrence were worse in group B (100% versus 77% P=0.009 and 11.3, CI 9.8–12.7 versus 4.9, CI 2.2–7.6 months, log rank P=0.004). Indexed low voltage area ≥0.24 cm2/mL could predict recurrence with 100% sensitivity and 77% specificity (area under the curve 0.923, P=0.007).ConclusionsLarger low voltage area but not dense scar is associated with the induction of multiple focal or reentry ATs, which are subsequently associated with longer procedure duration and worse acute and midterm clinical outcomes.
AU  - Mantziari,L
AU  - Butcher,C
AU  - Shi,R
AU  - Kontogeorgis,A
AU  - Opel,A
AU  - Chen,Z
AU  - Haldar,S
AU  - Panikker,S
AU  - Hussain,W
AU  - Jones,DG
AU  - Gatzoulis,MA
AU  - Markides,V
AU  - Ernst,S
AU  - Wong,T
DO  - 10.1161/JAHA.118.010535
PY  - 2019///
SN  - 2047-9980
TI  - Characterization of the mechanism and substrate of atrial tachycardia using ultra-high-density mapping in adults with congenital heart disease: Impact on clinical outcomes
T2  - Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease
UR  - http://dx.doi.org/10.1161/JAHA.118.010535
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000460144600008&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/68158
VL  - 8
ER  -
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