Topology-guided Ablation of Atrial Tachycardia

Following ablation of atrial tachycardia (AT), the tachycardia circuit may switch to a different driver with a slower cycle length instead of terminating.Our aim is to investigate this phenomenon using principles from topology.We apply the index theorem from topology, which states that the sum of all topological charges (TC) must equal zero.Thus, every clockwise rotation (TC = -1) must be paired with a counterclockwise rotation (TC = +1), though these rotations may not always fully complete.Results: To test this hypothesis, 572 unique simulations were generated on a spherical surface with 2D circular boundaries.Additionally, virtual ablations were performed to identify the ablation line that terminates tachycardia.Finally, 24 clinical ATs were retrospectively analyzed.The index theorem was satisfied in 100% of simulations.Virtual ablation successfully terminated tachycardia when boundaries with opposite TC were interconnected, while incorrect ablation slowed the tachycardia cycle length.All 24 clinical cases confirmed these findings.Conclusion: Reentrant atrial tachycardias are sustained by pairs of counterrotating patterns, and tachycardia is only terminated when boundaries with opposite TC are connected.