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Funding Acknowledgements NA OnBehalf NA Background High-density activation maps during complex atrial reentrant tachycardias are challenging to interpret as they include the activation patterns of active and passive circuits. Entrainment mapping provides the identification of the active tachycardia circuit. However, current electroanatomic mapping systems are not capable to color-coded the information obtained from entrainment maneuvers. Objectives We sought to describe a mapping approach for ablation of complex atrial reentrant tachycardias in which high-density activation maps are transformed into low-density activation maps only displaying the active part of the tachycardia circuit. Methods We included consecutive patients with atypical atrial flutter. A high-density activation map was acquired during the index tachycardia. Subsequently, entrainment maneuvers were performed to generate a low-density activation map in which only the activation of the atria directly involved in the flutter circuit was displayed. Results Seventeen patients were included 82% male, mean age was 62 ± 7 years. Structural heart disease was present in 59% and 53% had a prior left atrial ablation procedure. Low-density activation maps were successfully generated from an average of 14 ± 3 entrainment points. Twenty circuits (95%) were identified in the left atrium and 1 (5%) in the right atrium. Ablation guided by low-density mapping successfully terminated all ARTs in 267 ± 353 seconds of radiofrequency application. Conclusion Low-density mapping based on entrainment maneuvers provides a precise delineation of the active circuit during complex ARTs and resulted in successful arrhythmia termination. This approach can be easily incorporated into clinical practice.

Funding Acknowledgements NA OnBehalf NA Background Ablation of left atrial reentrant tachycardias (ART) is challenging since they usually occur in the setting of complex diseased atrial tissue either in patients with structural heart disease or after ablation of atrial fibrillation. In these cases, scarred tissue or previous ablation lines make the circuits more complex. We have developed a mapping approach in which an activation map that only contains the active circuit is generated from entrainment maneuvers. Purpose To describe the electrophysiological characteristics of the circuits in patients with structural heart disease and previous left atrial ablation. Methods Consecutive patients with documented atypical flutter were included. A high density activation map was generated during the index arrhythmia and subsequently, entrainment maneuvers were performed to delineate the active circuit. Results Seventeen patients (82% males, average age 62+-7 years, 59% structural heart disease and 53% with a previous left atrial ablation) underwent 20 procedures. Twenty-one circuits were identified (20 in the left atrium and 1 in the right atrium). Of all LA circuits, 15 were macroreentrant (8 roof dependent, 4 perimitral and 3 related to a gap after AF ablation. Four out of 5 microreentrant circuits were related to the left atrial appendage and 1 was identified in the septum. Overall, procedural duration and fluoroscopy time was 176 ± 55 minutes and 27 ± 13 minutes, respectively. Roof-dependent ARTs and gap-related ARTs after AF ablation exhibited a significantly longer TCL (359 ± 99 ms and 331 ± 47 ms, respectively, p Conclusions The cycle length of complex atrial reentrant tachycardias is apparently related to the location and characteristics of the circuits. This feature can be of help at the time of approaching the mapping and ablation of this tachycardias.

Introduction Remote monitoring (RM) of cardiac devices is a technology established in clinical practice. The early activation of RM is associated with greater survival. The RM of leadless pacemakers consists of a non-automatic remote interrogation (RI), however factors such as age, the monitoring center and the type of device delivered can condition the adequate adherence to the system. Purpose Describe the results of RM in patients with leadless pacemakers in the clinical practice of a tertiary referral hospital. Methods All patients with leadless pacemakers were included. Since October 2017, RM was offered to all new patients and to previously implanted patients who had an elevated threshold. Clinical and demographic characteristics were analyzed. The following variables were evaluated: Activation (first RI), early activation (activation occurring before 90 days from the implant or from the medical order), premature activation (activation before 15 days), and adherence to follow-up (patients with almost one RI after 12 months from activation). Results A total of 142 patients have been implanted with a leadless pacemaker, of which 56 patients were offered RM, being accepted in 96% of the cases (54 patients, 88±6 years old, 54% males). A 54% patients received a RM using App based technology. During a mean follow-up of 200 days, 7 deaths occurred (13%). 100% of the patients have performed the activation, being in all cases an early activation, and in 50% (26 patients) it has been premature activation. 32 patients have follow-up longer than 12 months and all are adherent to RM. There are no differences in the percentage of activation or adherence depending on the type of monitor. Conclusions The implementation of RM program in old patients with a leadless pacemaker has a high acceptance rate, achieving an early activation in all patients. The adherence to this technology remains high despite the limitation of a non automatic transmission. RM using App based technology is possible in spite of the age.