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

Chugh, Aman; Latchamsetty, Rakesh; Oral, Hakan; Elmouchi, Darryl; Tschopp, David; Reich, Scott; Igic, Petar; Lemerand, Tammy; Good, Eric; Bogun, Frank; Pelosi, Frank; Morady, Fred

doi:10.1161/circulationaha.105.580936

Cited by 101 publications

(85 citation statements)

References 20 publications

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“…The ECG characteristics seemed to vary after the prior AF ablation. An extensive pulmonary vein ablation may alter the normal activation pattern of the left atrium, and typical flutter may not appear as a typical feature of the surface electrogram [2]. These atypical 12 lead ECG features of common flutter may be incorrectly diagnosed as another type of atrial tachyarrhythmia.…”

Section: Nd Session (May 2010)mentioning

confidence: 99%

Unexplained Irreversible Sudden Termination of an Atypical Atrial Tachycardia for Atrial Fibrillation - What is the Mechanism?

Kino¹,

Kurotobi²,

Ito³

et al. 2018

Clin Med Img Lib

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KeywordsAtypical atrial tachycardia, Catheter ablation, Sudden termination IMAGE ARTICLE Check for updates CaseA 56-year-old woman without any significant past illnesses was suffering from frequent palpitations due to drug refractory paroxysmal atrial fibrillation (AF). The findings from the chest X-ray, laboratory data including the thyroid hormone level, and echocardiography data Key Clinical MessageCareful attention should be paid to the area behind the Eustachian ridge, if an unexpected sudden termination of an AT occurs after a prior cavo-tricuspid isthmus ablation. The surface electrocardiogram during an atrial tachycardia (AT) (a); The P wave polarity during the AT was biphasic in leads II, III, and aVF, and flat in leads I and V1. The AT cycle length was 500 ms. The course of the AT without covering the entire cycle length can be visualized from the CS ostium to the LRA (b) (arrow; red→yellow→green→blue→purple).LRA: Lateral right atrium.

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Section: Nd Session (May 2010)mentioning

confidence: 99%

Unexplained Irreversible Sudden Termination of an Atypical Atrial Tachycardia for Atrial Fibrillation - What is the Mechanism?

Kino¹,

Kurotobi²,

Ito³

et al. 2018

Clin Med Img Lib

View full text Add to dashboard Cite

show abstract

“…This is all the more relevant considering that in the setting of markedly abnormal atrial substrate after AF ablation, CTI-dependent AT rarely manifests with a typical saw-tooth appearance on 12-lead ECG. 10 Focused segmental LA activation mapping should be performed next to exclude the most frequent LA macroreentries. 8 For this purpose, the 2-axis activation of both the anterior and the posterior LA wall is first considered: the vertical axis activation (ascending or descending wavefront) and the septolateral axis activation of its annular segments ( Figure 6A).…”

Section: Proximal To Distal Cs Activationmentioning

confidence: 99%

Pattern and Timing of the Coronary Sinus Activation to Guide Rapid Diagnosis of Atrial Tachycardia After Atrial Fibrillation Ablation

Pascale

Roten

Scherr

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-Atrial tachycardias (AT) during or after ablation of atrial fibrillation frequently pose a diagnostic challenge.We hypothesized that both the patterns and the timing of coronary sinus (CS) activation could facilitate AT mapping. Methods and Results-A total of 140 consecutive postpersistent atrial fibrillation ablation patients with sustained AT were investigated by conventional mapping. CS activation pattern was defined as chevron or reverse chevron when the activations recorded on both the proximal and the distal CS dipoles were latest or earliest, respectively. The local activation of mid-CS was timed with reference to P peak -P peak (P-P) interval in lead V1. A ratio, mid-CS activation time to AT cycle length, was computed. Of 223 diagnosed ATs, 124 were macroreentrant (56%) and 99 were centrifugal (44%). When CS activation was chevron/reverse chevron (n=44; 20%), macroreentries were mostly roof dependent. With reference to P-P interval, mid-CS activation timing showed specific consistency for peritricuspid and perimitral AT. Proximal to distal CS activation pattern and mid-CS activation at 50% to 70% of the P-P interval (n=30; 13%) diagnosed peritricuspid AT with 81% sensitivity and 89% specificity. Distal to proximal CS activation and mid-CS activation at 10% to 40% of the P-P interval (n=44; 20%) diagnosed perimitral AT with 88% sensitivity and 75% specificity. Conclusions-The analysis of the patterns and timing of CS activation provides a rapid stratification of most likely macroreentrant ATs and points toward the likely origin of centrifugal ATs. It can be included in a stepwise diagnostic approach to rapidly select the most critical mapping maneuvers. (Circ Arrhythm Electrophysiol. 2013;6:481-490.)

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“…Although extensive prior ablation may alter the surface ECG morphology of the tachycardia, 23 the P-wave morphology may be quite useful when only PV isolation has been performed. One must obtain a clear P-wave that is not obstructed by a superimposed QRS or T wave.…”

Section: Surface Ecg Recognitionmentioning

confidence: 99%

Atrial Tachycardias Occurring After Atrial Fibrillation Ablation: Strategies for Mapping and Ablation

Mountantonakis¹,

Gerstenfeld²

2010

J.A.F.I.B

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The occurrence of left atrial tachycardias (AT) after catheter ablation for atrial fibrillation (AF) is common, especially after more extensive ablation of persistent AF. These AT are invariably symptomatic and often do not respond to medical therapy. The initial strategy involves ventricular rate control, cardioversion, and observation as some tachycardias may resolve with time. For persistent ATs, effective management frequently requires catheter intervention. Careful characterization of the tachycardia mechanism is essential in designing an effective ablation strategy that would also avoid further creation of pro-arrhythmic substrate. With this review, we summarize the incidence, mechanism, diagnosis and treatment of ATs occurring after AF ablation.tachycardias. Using this approach, AT incidence has ranged from 10% 9 to 30%. 3,8,10,11 When ablation of complex fractionated electrograms alone is performed, post ablation AT may occur in approximately 15-25% of patients.5, 12 With a more extensive ablation involving PVI isolation, empiric lines and electrogram based ablation all performed during the same procedure, the incidence of AT has been reported as high as 50%.3 , 7, 13, 14 Early versus Late Recurrence AT can occur early or late after AF ablation. Early ATs are defined as AT occurring within 3 months after ablation and late ATs those that occur after the 3 month post-ablation period. The incidence of AT is particularly high in the early period post ablation with 89% of all ATs occurring the first month, 9% in the second and 2% in the third month.13 Although early AT occurrence does predict late AT or recurrence of AF 13, 15 approx imately one-third of tachycardias may resolve with conservative management. 16 The presence of hypertension, persistent AF, left atrial (LA) size>4 cm, presence of structural heart disease and the lack of a successful ablation of all targeted PV have been independently correlated with early atrial tachyarrhythmias occurrence. 16,17 The much higher incidence of AT during the early post-ablation period may partially be related to radiofrequency related inflammatory changes. Until the development of well defined fibrosis, tissue edema and inflammation can be pro-arrhythmic. In addition, like in all cases of acute local cardiac inflammation, ablation is likely to mount a systemic inflammatory response. Inflammation both at tissue and systemic levels are related to the development of arrhythmias. ATs that persist after a 3 month period or occur late after AF ablation typically do not usually resolve spontaneously and warrant intervention. 13 Mechanism and PreventionPost ablation ATs can be divided based on their mechanism as focal or macro-reentrant [ Figure 1]. The mechanism of AT is usually related to the www.jafib.com

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

Cited by 101 publications

References 20 publications

Unexplained Irreversible Sudden Termination of an Atypical Atrial Tachycardia for Atrial Fibrillation - What is the Mechanism?

Unexplained Irreversible Sudden Termination of an Atypical Atrial Tachycardia for Atrial Fibrillation - What is the Mechanism?

Pattern and Timing of the Coronary Sinus Activation to Guide Rapid Diagnosis of Atrial Tachycardia After Atrial Fibrillation Ablation

Atrial Tachycardias Occurring After Atrial Fibrillation Ablation: Strategies for Mapping and Ablation

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