Atrial Tachycardia After Circumferential Pulmonary Vein Ablation of Atrial Fibrillation

Abstract

Approximately 90% of ATs after CPVA are re-entrant, and nearly all are related to gaps in prior ablation lines. These findings suggest that the prevalence of these arrhythmias may be reduced by limiting the number of linear lesions, demonstration of linear block, and pulmonary vein disconnection during the initial AF procedure.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…The role of additional lines in cases of persistent AF remains controversial. 508 The recently completed STAR-AF study of ablation strategies for persistent AF showed no improvement in ablation efficacy for linear lesions plus PVI vs PVI alone. 245 The Catheter Ablation of Persistent Atrial Fibrillation (CHASE-AF) study also revealed that the addition of linear lesions and defragmentation of PVI did not improve outcomes for ablation of persistent AF compared with PVI alone.…”

“…The role of posterior wall isolation in cases of persistent AF also remains controversial. 508 For patients with persistent or long-standing persistent AF, 22% of the writing group members perform posterior wall isolation at the time of an initial AF ablation procedure and 38% of the writing group members perform posterior wall isolation for repeat AF ablation procedures in patients with persistent and long-standing persistent AF. Based on this information and a review of the literature, the writing group recommends that posterior wall isolation might be considered during an initial or repeat AF ablation for paroxysmal, persistent, or long-standing persistent AF (Class IIb, LOE C-LD, Table 3).…”

“…498,508,699,700,701 The unique part of this system is that the lumen of the catheter contains a fiber optic endoscope that allows PVI under direct visualization. The balloon is compliant, allowing a variable inflation diameter from 25–32 mm, depending on PV size, and is delivered via a 16 Fr outer-diameter steerable sheath.…”

“…253,436,507,508,622,623, 624,625,630,870,871,995,996,997,998,999,1000,1001,1002 Most of these tachycardias originate in the LA, although RA cavotricuspid isthmus (CTI)-dependent flutters might also occur. Patients with a regular AT of new onset might complain of worsening symptoms due to a faster mean ventricular rate (frequently 2:1 ventricular response) than that during AF preablation.…”

“…447,508,933, 998 Occurrence of early AT within 3 months after ablation predicts occurrence of both late AT and AF. 1003,1004,1005 However, because up to 49% of ATs resolve with time, ablation should not be undertaken for early AT occurrence unless symptoms cannot be controlled.…”