Focal atrial tachycardia ablation: Highly successful with conventional mapping

Manolis, Antonis S.; Lazaridis, Kyriakos

doi:10.1007/s10840-018-0493-1

Cited by 9 publications

(9 citation statements)

References 65 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.…”

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confidence: 51%

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

Ballı

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%

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

Ballı

Küçük

2020

Cardiol Young

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“…4.8% of patients had an early recurrence and 19% had a late recurrence during the observation period of 12 months 6 . As ablation procedures and mapping techniques evolved, benefits of EAM over conventional mapping systems were noted, in particular for complex cases or for those with recurrent tachycardia after a conventional mapping approach 4,6,8,17,18 …”

Section: Discussionmentioning

confidence: 99%

“…Patients suffering from recurrent FAT are often highly symptomatic and uncontrolled FAT can cause tachymyopathic impairment of left ventricular function 3 . Efficacy of medical treatment is limited, whereas catheter ablation is a feasible and successful therapeutic option for symptomatic FAT 4 . Thus, the current ESC guideline prefers catheter ablation of chronic FAT especially if incessant or causing tachycardiomyopathy instead of antiarrhythmic treatment (recommendation class I) 1 …”

Section: Introductionmentioning

confidence: 99%

“…With the increasing importance of catheter ablation for the treatment of FAT, long term success‐rates have been published. In previous procedures conventional mapping technique was utilized with acute success rates varying from 60% to 70%, but with the implementation of electroanatomical mapping (EAM) even higher success rates could be achieved (80%–90%) 4–7 . Still, mapping the tachycardia remains challenging with established EAM systems, for example, CARTO or Ensite NavX, as frequent extensive and accurate mapping is required for identifying the origin of the tachycardia 4,6,8,9 .…”

Section: Introductionmentioning

confidence: 99%

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Single‐center experience of ultra‐high‐density mapping guided catheter ablation of focal atrial tachycardia

Kellnar

Fichtner

Mehr

et al. 2022

Clinical Cardiology

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Introduction Catheter ablation is the treatment of choice for recurrent focal atrial tachycardia (FAT) as medical therapy is limited. Routinely, a three‐dimensional mapping system is used. Whether or not optimized signal detection does improve ablation success rates has not yet been investigated. This retrospective cohort study compared ablation procedures using an ultra‐high‐density mapping system (UHDM, Rhythmia, Boston Scientific) with improved signal detection and automatic annotation with procedures using a conventional electroanatomic mapping system (CEAM, Biosense Webster, CARTO). Methods All patients undergoing ablation for FAT using UHDM or CEAM from April 2015 to August 2018 were included. Endpoints comprised procedural parameters, acute success as well as freedom from arrhythmia 12 months after ablation. Results A total of 70 patients underwent ablation (48 with UHDM, 22 with CEAM). No significant differences were noted for parameters like procedural and radiation duration, area dose, and RF applications. Acute success was significantly higher in the UHDM cohort (89.6% vs. 68.2%, p = .03). Nevertheless, arrhythmia freedom 12 months after ablation was almost identical (56.8% vs. 60%, p = .87), as more patients with acute success of ablation presented with a relapse during follow‐up (35.0 vs. 7.7%, p = .05). Conclusion Acute success rate of FAT ablation might be improved by UHDM, without an adverse effect on procedural parameters. Nevertheless, further research is needed to understand the underlying mechanism for increased recurrence rates after acute successful ablation.

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“…The acute success rate for ablation of focal ATs is approximately 85–90%, and freedom from recurrence without antiarrhythmic drug therapy is 60–90%. [39,40] Higher success is achievable in patients with single foci and structurally normal hearts.…”

Section: Outcomes After Catheter Ablationmentioning

confidence: 99%

Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation

Markowitz

Thomas

Liu

et al. 2019

Arrhythm Electrophysiol Rev

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Atrial tachycardias (ATs) may be classified into three broad categories: focal ATs, macroreentry and localised reentry – also known as ‘microreentry’. Features that distinguish these AT mechanisms include electrogram characteristics, responses to entrainment and pharmacological sensitivities. Focal ATs may occur in structurally normal hearts but can also occur in patients with structural heart disease. These typically arise from preferential sites such as the valve annuli, crista terminalis and pulmonary veins. Macro-reentrant ATs occur in the setting of atrial fibrosis, often after prior catheter ablation or post atriotomy, but also de novo in patients with atrial myopathy. High-resolution mapping techniques have defined details of macro-reentrant circuits, including zones of conduction block, scar and slow conduction. Localised reentry occurs in the setting of diseased atrial myocardium that supports very slow conduction. A characteristic feature of localised reentry is highly fractionated, low-amplitude electrograms that encompass most of the tachycardia cycle length over a small diameter. Advances in understanding the mechanisms of ATs and their signature electrogram characteristics have improved the efficacy and efficiency of catheter ablation.

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Focal atrial tachycardia ablation: Highly successful with conventional mapping

Cited by 9 publications

References 65 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

Single‐center experience of ultra‐high‐density mapping guided catheter ablation of focal atrial tachycardia

Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation

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