The INPACT pace-mapping technique identified the critical isthmus in non-sustained uncommon AFL, enabling successful ablation with no recurrence at 6 months.
Does the INPACT pace-mapping technique successfully identify critical isthmuses and guide ablation in patients with non-sustained uncommon atrial flutter?
The novel INPACT pace-mapping technique successfully identified the critical isthmus for ablation during sinus rhythm in a patient with non-sustained uncommon atrial flutter, resulting in freedom from arrhythmia at 6 months.
Absolute Event Rate: 0% vs 0%
Abstract Background Mapping uncommon atrial flutter (AFL) remains challenging when tachycardia cannot be sustained during the procedure. We developed a novel pace-mapping methodology for identifying critical isthmuses in non-sustained uncommon AFL circuits during sinus rhythm. Case summary A 70-year-old male presented with persistent AFL (cycle length 370 ms) following mitral valve repair with concomitant surgical pulmonary vein isolation. During electrophysiological study, the tachycardia terminated spontaneously, precluding conventional mapping. We implemented the INPACT (Isthmus Identification in Non-Sustained Uncommon Atrial Flutter PACing Technique), combining Intracardiac Pattern-match ScOring (iPASO) technology with systematic pace-mapping during sinus rhythm. A novel Isthmus Ratio (IR) metric differentiated potential isthmus sites among those with high morphological correlation (iPASO ≥90%). The critical isthmus was identified within a low-voltage area adjacent to the atrial septotomy line. Radiofrequency ablation targeting the site with the highest IR value eliminated the tachycardia with no recurrence at 6-month follow-up. Discussion The INPACT technique enables identification of critical isthmuses without requiring sustained tachycardia, offering a solution for challenging cases where conventional mapping is limited by non-sustained arrhythmia. This approach may improve procedural efficiency and outcomes in complex uncommon AFL.
Munakata et al. (Sat,) reported a other. The INPACT pace-mapping technique identified the critical isthmus in non-sustained uncommon AFL, enabling successful ablation with no recurrence at 6 months.