Catheter Ablation of Atypical Atrial Flutter and Atrial Tachycardia Within the Coronary Sinus After Left Atrial Ablation for Atrial Fibrillation

Abstract

The musculature of the CS serves as a critical component of the re-entry circuit in approximately 25% of patients with atypical flutter after ablation for AF. The CS may also generate focal atrial arrhythmias that may play a role in triggering and/or maintaining AF. Catheter ablation of these arrhythmias in the CS can be performed safely.

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

“…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.…”

“…For those with intolerable symptoms or continued late AT recurrence, detailed activation and entrainment mapping of the tachycardia results in effective ablation in approximately 90% of patients. 447,622,623,624,1006,1007,1008 …”

Characteristics of Cavotricuspid Isthmus–Dependent Atrial Flutter After Left Atrial Ablation of Atrial Fibrillation

“…[1][2][3] However, patients also may experience typical atrial flutter arising from the cavotricuspid isthmus (CTI) after ablation of AF. 4 Because LA ablation may alter the normal activation pattern of the LA, 2 it is possible that the 12-lead ECG of CTI-dependent flutter may not appear "typical" after AF ablation. However, the effects of LA ablation on the characteristics of CTI-dependent atrial flutter have not been described.…”

Catheter Ablation of Paroxysmal Atrial Fibrillation: Have We Achieved Cure with Pulmonary Vein Isolation?

“…As a result, post-ablation reentrant atrial tachycardias have been reported in up to 20% of patients treated with this approach. 18 As far as PV imaging modalities are concerned, ICE has shown to be of incremental value compared to PV angiography. 9 Marrouche et al reported the outcome of PVI in 315 patients; of these, 56 underwent ablation guided by circular mapping catheter and PV angiography, 107 underwent circular mapping catheter and ICE-guided PVI, and 152 underwent circular mappingguided ablation with titration of radiofrequency energy based on visualization of microbubbles by ICE.…”