Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation

Wasmer, Kristina; Mönnig, Gerold; Bittner, Alex; Dechering, Dirk G.; Zellerhoff, Stephan; Milberg, Peter; Köbe, Julia; Eckardt, Lars

doi:10.1016/j.hrthm.2012.06.007

Cited by 100 publications

(69 citation statements)

References 24 publications

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“…Development of regular ATs following point by point RF PV isolation has been described as its most frequent complication occurring in 2.9 to 31 % [2,[4][5][6][7][8]. They are often more symptomatic than AF prior to ablation due to higher ventricular rates [6].…”

Section: Discussionmentioning

confidence: 99%

“…Development of regular atrial tachycardias (ATs) has been reported as the most common complication after atrial fibrillation (AF) ablation with RF. In fact, ATs are reported to occur in 2.9-31 % [2][3][4][5][6][7][8] and often are more symptomatic than AF itself due to faster ventricular rates [9]. These tachyarrhythmias are usually caused by focal microreentry originating from reconnected PV ostia or macroreentry around anatomic barriers, such as previously isolated PVs or the mitral annulus [2,3].…”

Section: Introductionmentioning

confidence: 99%

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Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques

Juliá

Chierchia

Asmundis

et al. 2015

J Interv Card Electrophysiol

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques

Juliá

Chierchia

Asmundis

et al. 2015

J Interv Card Electrophysiol

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“…Various circuit sizes [12][13][14][15] (or focal propagation) may occur, all being highly dependent on the previously created lesions. 16 As expected, we found a majority of macroreentries (perimitral flutter, 17 roof-dependent flutters, or dual-loop reentry using both the roof and mitral isthmus, but few CTI dependent; Table).…”

Section: Mechanism Identificationmentioning

confidence: 99%

Selection of Critical Isthmus in Scar-Related Atrial Tachycardia Using a New Automated Ultrahigh Resolution Mapping System

Laţcu

Bun

Viera

et al. 2017

Circ: Arrhythmia and Electrophysiology

117

108

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Background— Accurate activation mapping of reentrant scar-related atrial tachycardias (AT) allows efficient radiofrequency ablation by targeting the critical isthmus (CI). We aimed to assess the electrophysiological properties of CI channels during mapping with the IntellaMap Orion basket and the Rhythmia system. Methods and Results— We prospectively studied 33 AT (post– atrial fibrillation ablation or surgical mitral valve repair). The noise of bipolar electrogram (EGM) was systematically measured at 10 prespecified sites, as well as on a standard catheter and on the surface ECG. Bipolar EGM of CI regions were analyzed for amplitude, duration, and conduction velocity. The isthmus region to be targeted was chosen based solely on propagation. For each AT, 25 684±14 276 EGMs were automatically annotated. Noise of the Orion EGM was 0.011±0.004 mV, lower than that of a standard catheter (0.016±0.019) and surface ECG (0.02±0.01; P <0.05). For reentrant AT, within the CI, bipolar EGM amplitude (0.08±0.11 mV) and conduction velocity (0.27±0.19 m/s) were lower than those orthodromically before (0.62±0.93 mV; 1±0.49 m/s) and after (0.80±1.59 mV; 1±0.73 m/s) the isthmus ( P <0.001 for all). In 97% of AT, ablation at the CI resulted in AT termination. No complications occurred. Conclusions— This new automated ultrahigh resolution mapping system produces low noise and allows accurate diagnosis of AT circuits. CI on reentrant scar-related AT showed much lower EGM amplitude with a significantly slower conduction velocity than the surrounding parts of the circuit. Ablation of the areas of slow conduction resulted in a high acute success.

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“…Focal atrial tachycardias occur less frequently (12% to 37%) and originate from smaller and limited anatomical regions with centrifugal passive activation of remaining parts of the atrium [198,199].…”

Section: Phrenic Nerve Injurymentioning

confidence: 99%

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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Atrial fibrillation is the most common sustained arrhythmia in clinical practice, associated with increased mortality, risk of stroke and heart failure, as well as the reduction of the quality of life. Atrial fibrillation may be encountered in young otherwise healthy individuals, due to the isolated electrophysiological disorder limited mostly to the pulmonary veins and posterior left atrial wall, or associated with the presence of advanced underlying heart disease and numerous cardiac and non-cardiac comorbidities with significant structural remodeling of the atrial myocardium. Due to limited efficacy and serious side effects of antiarrhythmic drugs, catheter ablation of atrial fibrillation, based on the pulmonary vein isolation for paroxysmal atrial fibrillation and adjunctive substrate modification for persistent atrial fibrillation, has emerged as an attractive and promissing alternative therapeutic option for selected patients with atrial fibrillation. In this review article, we discuss the electrophysiological left atrial abnormalities underlying lone atrial fibrillation and the role of pulmonary veins in pathophysiology of arrhythmia, and we summarize results of the studies on the long term outcome of catheter ablation of atrial fibrillation, as well as the studies on comparison of antiarrhythmic drugs with catheter ablation for treatment of atrial fibrillation. In addition, we present available data that provide better understanding of mechanisms, diagnosis, prevention and treatment of specific procedure-related complications and discuss current periprocedural anticoagulation strategies and their impact on the thromboembolic risk reduction.

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Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation

Cited by 100 publications

References 24 publications

Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques

Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques

Selection of Critical Isthmus in Scar-Related Atrial Tachycardia Using a New Automated Ultrahigh Resolution Mapping System

Catheter Ablation of Lone Atrial Fibrillation

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