Algorithm of Shalganov et al for the Chamber of Origin for Atrial Tachycardia: Macroreentry Tachycardia

Description

Shalganov et al developed simple algorithms for evaluating patients with atrial tachycardia. These can be used to localize the chamber of origin based on electrophysiologic findings. The authors are from Gottsegen Gyorgy Hungarian Institute of Cardiology (Budapest), Semmelweis Medical University and National Heart Hospital in Sofia, Bulgaria.

Examination: 8-polar catheter placed in coronary sinus and 20-polar catheter in the right atrium

Parameters:

(1) bi-atrial activation as percent of the tachycardia cycle length (TCL)

(2) isthmus-dependent atrial flutter (IDAF)

(3) cavotricuspid isthmus (CTI) entrainment

(4) right atrial (RA) activation as percent of TCL

(5) entrainment from multiple sites

Bi-Atrial Activation as Percent of TCL	Tachycardia
< 40%	focal
>= 40%	macroreentry

Patient selection: macroreentry atrial tachycardia

Postpacing Interval vs Tachycardia Cycle Length	Entrainment
< 30 milliseconds longer	positive
>= 30 milliseconds longer	negative
dissociation of the paced chamber from the tachycardia	negative

Features of atrial tachycardia arising in the right atrium

Typical IDAF	CTI Entrainment	RA Activation	Entrainment Multiple Sites
yes	positive	NA	NA
yes	negative	>= 50%	NA
yes	negative	40-49%	positive
no	NA	>= 50%	NA
no	NA	40-49%	positive

All other patterns indicate that the atrial tachycardia is arising from the left atrium.

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Description

Specialty

ICD-10