Acute and long-term outcome of focal atrial tachycardia ablation in the real world: results of the german ablation registry

Busch, Sonia; Forkmann, Mathias; Kuck, Karl‐Heinz; Lewalter, Thorsten; İnce, Hüseyin; Straube, Florian; Wieneke, Heinrich; Chun, K.R. Julian; Eckardt, Lars; Schmitt, Claus; Hochadel, Matthias; Senges, Jochen; Brachmann, Johannes

doi:10.1007/s00392-018-1204-8

Cited by 24 publications

(29 citation statements)

References 22 publications

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“…Some significant complications have been associated with catheter ablation of focal atrial tachycardia, including atrioventricular block, sinus node dysfunction, perforation, thrombus formation, pericardial effusion, phrenic nerve damage, thromboembolism, and cardiac arrest. [13][14][15] In our study, we did not encounter any permanent complications. One patient developed a second-degree atrioventricular block during ablation in the parahisian region.…”

mentioning

confidence: 51%

“…Other studies also reported higher fluoroscopy times in children and adults with focal atrial tachycardia who underwent a transcatheter ablation using three-dimensional electroanatomic mapping. 3,4,13 The mean fluoroscopy time was as high as 40 ± 20 minutes in some studies even with the utilisation of a three-dimensional mapping system. 4 In our study, fluoroscopy was required only for the transseptal puncture in nine patients with left-sided foci.…”

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confidence: 99%

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Transcatheter ablation using near-zero fluoroscopy in children with focal atrial tachycardia: a single-centre experience

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Küçük

2020

Cardiol Young

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Objective: Focal atrial tachycardia accounts for up to 10–15% of supraventricular tachycardiasubstrates in patients < 30 years. In this study, we aimed to demonstrate the outcome of transcatheter ablation procedures performed through three-dimensional electroanatomic mapping systems using minimal fluoroscopy in a paediatric cohort with focal atrial tachycardia. Methods: Forty-nine consecutive patients with focal atrial tachycardia who underwent an electrophysiologic study and a transcatheter ablation procedure in our hospital from September 2014 to February 2020 were included into the study. Results: The mean weight of the patients was 48.63 ± 15.4 kg, and the mean age was 14.56 ± 3.5 (5.5–18.4) years. The tachycardia was defined as incessant in 26 patients. Thirteen patients had left ventricular systolic dysfunction with a mean left ventricular ejection fraction of 38.47 ± 12.4% on echocardiography. The mean procedure time was 148.7 ± 94.5 minutes. Transseptal puncture and thus fluoroscopy were required in nine patients. The mean fluoroscopy time was 4.51 ± 5.9 minutes. No fluoroscopy was needed in ablations performed in the right atrium. The acute success rate of the ablation procedures was 97.9%. The mean follow-up period was 50.71 ± 23.5 months. Recurrence was noted in two patients (4.2%). Conclusion: The outcomes of three-dimensional electroanatomic mapping-guided transcatheter ablation procedures are promising with high acute success, low recurrence and complication rates in children with focal atrial tachycardia. The use of fluoroscopy can be significantly decreased with three-dimensional mapping systems in this group of patients.

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confidence: 51%

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confidence: 99%

Transcatheter ablation using near-zero fluoroscopy in children with focal atrial tachycardia: a single-centre experience

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Küçük

2020

Cardiol Young

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“…For focal ATs from the LA, acute success rates for ablation are about 85% . Recurrences are more common in patients who have multiple or biatrial foci.…”

Section: Outcomes After Ablating Left Atrial Tachycardiasmentioning

confidence: 99%

“…For focal ATs from the LA, acute success rates for ablation are about 85%. 51,52 Recurrences are more common in patients who have multiple or biatrial foci. In an earlier cohort of patients treated between 2007 and 2010, which preceded the introduction of contact force monitoring, arrhythmia freedom without antiarrhythmic drugs was 58%.…”

Section: Outcomes After Ablating Left Atrial Tachycardiasmentioning

confidence: 99%

“…In an earlier cohort of patients treated between 2007 and 2010, which preceded the introduction of contact force monitoring, arrhythmia freedom without antiarrhythmic drugs was 58%. 52 In patients with scar related left ATs, acute success for ablation has been reported to be 85%, with freedom from recurrent arrhythmias of 73% during intermediate term followup. 53 Lower success rates were reported for septal ATs and in those with idiopathic scar compared to those with prior surgical interventions or catheter ablation.…”

Section: Outcomes After Ablating Left Atrial Tachycardiasmentioning

confidence: 99%

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Approach to catheter ablation of left atrial flutters

Markowitz

Thomas

Liu

et al. 2019

Cardiovasc electrophysiol

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Left atrial tachycardias (ATs) most commonly occur after catheter or surgical ablation of atrial fibrillation and in patients with atrial myopathies. Pre‐existing scar in the left atrium (LA) can result in complex circuits, sometimes with narrow channels that can be detected with high‐resolution mapping. The most common forms of macroreentrant AT from the LA are variants of peri‐mitral and roof‐dependent reentry. Localized reentrant rhythms occur in the setting of fibrosis that gives rise to slow conduction and may occur adjacent to areas of prior ablation. The approach to treating these ATs involves first identifying the left atrial origin, defining the tachycardia circuit – which can be facilitated by ultrahigh density mapping and entrainment – and selecting a suitable isthmus to target for ablation. An important endpoint in ablating left atrial flutters is to establish and confirm bidirectional line of the block. Challenges in ablating these ATs include the presence of multiple tachycardias, defining circuits with complex activation patterns and achieving durable lines of block, particularly in the lateral mitral isthmus. Progress in treating these arrhythmias has come from new mapping technologies and the recognition of epicardial connections that allow for persistent conduction across ablation lesions. Also, advances in delivering energy to obtain complete transmural lesions promise to improve the long‐term success of ablating ATs from the LA.

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The characteristics and efficacy of catheter ablation of focal atrial tachycardia arising from an epicardial site

Yamamoto

Iwasaki

Fujimoto

et al. 2021

Clinical Cardiology

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Background Although epicardial structures around the atrium such as adipose tissue possess arrhythmogenicity, little is known about atrial tachycardias (ATs) originating from epicardial sites (Epi‐ATs). This study aimed to elucidate the prevalence, characteristics, and outcome after radiofrequency catheter ablation (RFCA) of Epi‐ATs and to reveal the association between Epi‐ATs and the epicardial structures. Methods The electrocardiographic, electrophysiologic, and anatomical properties and results of RFCA were analyzed in 42 patients with a total of 49 ectopic ATs. Results Six Epi‐ATs (12%) were observed in six patients (14%). Four of six were respiratory cycle‐dependent ATs and one was a swallowing‐induced AT. The Epi‐AT origins were adjacent to a pulmonary vein (five cases) and vein of Marshall (one case). A Valsalva maneuver or atropine infusion to define the arrhythmia mechanism affected the appearance of the Epi‐ATs. The congruity rate between epicardial adipose tissue and the AT origin was significantly higher (100% vs. 44%, p = .045), and the epicardial adipose tissue volume of the atrium was significantly larger (104.1 vs. 64.6 ml, p = .04) in the Epi‐AT group. Endocardial RFCA targeting the AT foci resulted in acute success in five of five cases. However, electrical isolation including of the AT foci resulted in acute failures (two of three cases) or a recurrence (one of one case). Conclusions Six Epi‐ATs were associated with thoracic veins and epicardial arrhythmogenic structures. The main cause provoking the Epi‐ATs was associated with autonomic nerve activity.

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Acute and long-term outcome of focal atrial tachycardia ablation in the real world: results of the german ablation registry

Abstract: In this large patient population, FAT ablation had a relatively high acute success rate with a low complication rate. During follow-up, the recurrence rate was high, particularly in biatrial location. This was frequently predicted by an early recurrence during hospitalization.

Cited by 24 publications

References 22 publications

Transcatheter ablation using near-zero fluoroscopy in children with focal atrial tachycardia: a single-centre experience

Transcatheter ablation using near-zero fluoroscopy in children with focal atrial tachycardia: a single-centre experience

Approach to catheter ablation of left atrial flutters

The characteristics and efficacy of catheter ablation of focal atrial tachycardia arising from an epicardial site

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