Atrial Tachycardia Transition During Ablation of Persistent Atrial Fibrillation: What is the Mechanism?

Arantès, Leonardo; Klein, George J.; Jaı̈s, Pierre; Matsuo, Seiischiro; Lim, Kang Teng; Knecht, Sébastien; Haı̈ssaguerre, Michel

doi:10.1111/j.1540-8167.2007.00870.x

Cited by 2 publications

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“…2 and 3). 6 We were fortunate to make this observation since a catheter generally remains in the CS throughout the study during our procedures and the new tachycardia after the type 1A transition was usually macro‐reentry related either to the cavotricuspid isthmus or perimitral region. That is, a recording electrode relatively close to the ablation site was available to serve as an analogue for measuring the “postpacing interval” of entrainment.…”

Section: Discussionmentioning

confidence: 99%

Tachycardia Transition During Ablation of Persistent Atrial Fibrillation

Arantès¹,

Klein²,

Jaı̈s³

et al. 2010

Journal of Cardiovascular Electrophysiology

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Transition to a second AT occurs frequently in the midst of ablation of AT in persistent AF patients. This transition occurs most commonly abruptly within the range of a single cycle length of the original AT. This is best explained by a continuation of AT that was "present" simultaneously with the pretransition tachycardia, being "entrained" (for a reentrant tachycardia) or "overdriven" for an automatic focal tachycardia. The presence of multiple tachycardia mechanisms active simultaneously would be consistent with the eclectic pathophysiology of persistent AF.

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Section: Discussionmentioning

confidence: 99%

Tachycardia Transition During Ablation of Persistent Atrial Fibrillation

Arantès¹,

Klein²,

Jaı̈s³

et al. 2010

Journal of Cardiovascular Electrophysiology

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“…Dual‐loop AT was defined as the concomitance of 2 simultaneously reentrant circuits, a difference between the PPI and TCL from the dominant circuit of ≤20 milliseconds, and a sudden transformation to a new reentrant tachycardia maintained by the second circuit after ablation of the dominant tachycardia . Dual‐loop AT is common in patients with postcardiac surgery, especially in correlation with congenital heart disease .…”

Section: Commentarymentioning

confidence: 99%

Dual‐Loop Bi‐Atrial Macroreentrant Atrial Tachycardia in a Patient With Modified Cox Maze IV: Where Is the Initial Ablation Target?

Hayashi

Mitsuhashi

Fujita

et al. 2015

Cardiovasc electrophysiol

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Case PresentationA 75-year-old man with atrial fibrillation, who underwent valve (mitral and tricuspid) plasty with a modified Cox-Maze IV, was referred for the ablation of atrial tachycardia (AT). At the beginning of the procedure, the baseline tachycardia cycle length (TCL) was 300 milliseconds. No pulmonary vein potentials were recorded, and a 3-dimensional (3D) activation map (CARTO, Biosense Webster Inc., Diamond Bar, CA, USA) showed a clockwise peri-mitral atrial tachycardia (PMAT) pattern (Fig. 1). With the entrainment pacing from the multiple sites at the left atrium (LA) in the 7-2 o'clock direction of the mitral annulus (MA), a postpacing interval (PPI)-TCL was ࣘ20 milliseconds (Fig. 1). The PPI-TCL at the multiple sites of the coronary sinus (CS) opposite of LA 3-6 o'clock direction of MA was ࣘ20 milliseconds, although the PPI-TCL at the LA 3-6 o'clock direction of MA was >20 milliseconds. Interestingly, the PPI-TCL at both the CS ostium and the right atrial septum was ࣘ20 milliseconds. Furthermore, the RA activation map showed that the counter-clockwise cavotricuspid isthmus (CTI) dependent AT although the PPI-TCL at the CTI was >20 milliseconds ( Fig. 1). Based upon these observations, where is the initial ablation target? CommentaryDual-loop AT was defined as the concomitance of 2 simultaneously reentrant circuits, a difference between the PPI and TCL from the dominant circuit of ࣘ20 milliseconds, and a sudden transformation to a new reentrant tachycardia maintained by the second circuit after ablation of the dominant tachycardia.1 Dual-loop AT is common in patients with postcardiac surgery, especially in correlation with congenital heart disease.2 Typically, the CTI dependent AT and the RA atriotomy-dependent AT present simultaneously. In this case, the 3D activation map of the initial AT demonstrated the concomitance of clockwise PMAT and counter-clockwise CTI dependent AT (Fig. 1). The initial PPI mapping revealed that the dominant tachycardia was the PMAT. The PPI mapping showed that the endocardial LA 3-6 o'clock direction of the MA opposite the CS was out of the reentrant circuit. Interestingly, both the CS and right atrium septum were part of the reentrant circuit. The reason for the reentrant circuit of PMAT including the bi-atrium and epicardium was that the modified Cox-Maze IV procedure, especially the radiofrequency line from the incisional line of the LA to the posterior MA, has been led to exclude the endocardial LA 3-6 o'clock direction of the MA from the reentrant circuit. Thereby, the tachycardia developed as bi-atrial AT utilizing the CS.Bi-atrial AT has been reported in patients after mitral valve plasty or ablation of the anterior LA line for PMAT.3,4 Interatrial conduction normally occurs via anatomically distinct connections such as the Bachmann bundle, around the fossa ovalis, and rarely in the CS.5 Anterior LA line ablation has been led to exclude the LA septal wall from the reentrant circuits of PMAT, and thereby AT has developed to bi-atrial AT via interatrial connections. ...

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Atrial Tachycardia Transition During Ablation of Persistent Atrial Fibrillation: What is the Mechanism?

Cited by 2 publications

References 18 publications

Tachycardia Transition During Ablation of Persistent Atrial Fibrillation

Tachycardia Transition During Ablation of Persistent Atrial Fibrillation

Dual‐Loop Bi‐Atrial Macroreentrant Atrial Tachycardia in a Patient With Modified Cox Maze IV: Where Is the Initial Ablation Target?

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