Induced Atrial Tachycardia After Circumferential Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation: Electrophysiological Characteristics and Impact of Catheter Ablation on the Follow‐Up Results

Chang, Shih‐Lin; Lin, Yenn‐Jiang; Tai, Ching‐Tai; Liu, Shin-Huei; Tuan, Ta‐Chuan; Udyavar, Ameya R.; Hu, Yu‐Feng; Chiang, Shuo-Ju; Wongcharoen, Wanwarang; Tsao, Hsuan‐Ming; Ueng, Kwo-Chang; Higa, Satoshi; Lee, Pi-Chang; Chen, Shih‐Ann

doi:10.1111/j.1540-8167.2008.01358.x

Cited by 51 publications

(67 citation statements)

References 28 publications

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“…[25][26][27] Delineation of the inducible ATs with noninducibility after circumferential PV isolation may be helpful to prevent the recurrence of ATs. 16) In the present study, the inducible ATs after creating the LARL could be successfully mapped and delineated in almost all cases by using a deductive entrainment mapping technique. Moreover, the absence of residual inducible ATs at the endpoint of the CA procedure seemed to predict prevention of the occurrence of ATs during follow-up.…”

Section: Discussionmentioning

confidence: 83%

“…LA anterior wall ATs and ATs surrounding right or left PVs could be observed after circumferential PV isolation or the stepwise approach, 16,19) and the mechanism responsible for the ATs located in the left anterior wall could be localized reentry within a low voltage zone. In addition, the intervenous ridge, the so-called "PV carina," where the transmural myocardial thickness of the PV-atrial junction and epicardial atrial fibers acting as an electrical connection across the ablation line, may have facilitated development of the substrate mainly responsible for the ATs surrounding right and left PVs.…”

Section: Discussionmentioning

confidence: 99%

“…As AT was induced from multiple sites with administration of isoproterenol, the aggressive induction protocol may have had a significant impact on the increased AT inducibility. 16) LARL creation further promoted the increased incidence of macroreentrant ATs originating from the LA, including mitral annulus-dependent ATs, ATs surrounding right PVs, and septal ATs. The additional created LARL, the boundary zone anterior to the right PVs corresponding to the limbus of the fossa ovalis, and the mitral annulus acting as a lateral functional barrier may have supported the stable circuit of these types of macro-reentrant ATs originating from the LA.…”

Section: Discussionmentioning

confidence: 99%

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Electrophysiological Features of Atrial Tachyarrhythmias After the Creation of a Left Atrial Roof Line During Catheter Ablation of Atrial Fibrillation

et al. 2011

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SummaryLeft atrial roof line (LARL) can prevent the perpetuation of atrial fibrillation (AF) by delineation of the arrhythmogenic substrate, but it may be associated with an increased incidence of atrial tachycardia (AT). This study was performed to evaluate the characteristics and clinical implications of inducible AT after LARL.A total of 139 consecutive patients with AF who underwent catheter ablation were prospectively enrolled in this study. LARL was required to prevent the perpetuation of AF in 98 of 139 patients (71%). LARL significantly reduced the incidence of inducible AF (before versus after: 100% versus 44%, respectively, P < 0.01), whereas it significantly increased the incidence of AT (18% versus 63%, P < 0.01). ATs were observed after LARL in 62 of 98 patients (63%), and these circuits were determined in 99 of 112 stable ATs (88%), including tricuspid isthmus-dependent (n = 35), mitral annulus (n = 22), septal (n = 15), surrounding right pulmonary veins (PVs) (n = 12), coronary sinus (CS) ostium (n = 4), upper loop (n = 4), surrounding left PVs (n = 4), and LA anterior wall (n = 3). Catheter ablation (CA) successfully terminated 111 of 122 stable ATs (91%) during CA. The occurrence of AT after CA was significantly higher in patients with than in those without residual AT (26% versus 2%, P < 0.05).Induced AT with a stable circuit after LARL creation could be mapped, and delineation of the induced AT may lead to a favorable outcome. An additional left atrial roof line (LARL) after pulmonary vein (PV) isolation prevents AF perpetuation by delineating the arrhythmogenic substrate with favorable clinical results, although it may be associated with an increased incidence of AT.6) In particular, AT with a macro-reentrant mechanism may be highly inducible after LARL creation.However, the characteristics of the AT have not been fully investigated after complete electrical PV isolation and creation of a complete electrical LARL in patients with AF. In this study, we evaluated the influence of LARL after PV isolation on the inducibility of atrial tachyarrhythmias (AF and ATs), and then assessed the electrical characteristics of the inducible ATs before and after LARL creation. MethodsStudy population: The study population consisted of 139 consecutive patients with drug-refractory episodes of AF who underwent initial radiofrequency CA (Table I). The mean age of the patients was 62 years, 82 (57%) were male, and 41 (29%) had persistent AF lasting more than 7 days (long-standing AF more than 6 months; 15 (11%)). Patients were considered for ablation based on the presence of symptomatic AF resistant to ≥ 1 antiarrhythmic drug. Cardiac structural findings assessed by ultracardiography are shown in Table II. No specific exclusion criteria were used. All antiarrhythmic agents were generally discontinued for at least 3 days before CA. Amiodarone was withdrawn at least 2 months before the procedure. All patients provided written informed consent for the electrophysiological study. This study was approved by our insti...

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Electrophysiological Features of Atrial Tachyarrhythmias After the Creation of a Left Atrial Roof Line During Catheter Ablation of Atrial Fibrillation

et al. 2011

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“…2,3,[28][29][30] Gerstenfeld et al reported that persistent focal atrial tachycardia occurred after segmental PV isolation, with the reentrant circuit located at the PV ostium. 28 Chae et al 29 also reported that approximately 90% of the atrial tachycardias that develop after circumferential PV isolation have a reentrant mechanism and they considered that gaps might be related to prior ablation lines.…”

Section: Prevention Of Gap Formation and Activation Mapping To Guide mentioning

confidence: 99%

“…Using the 3D mapping system, Chang et al found that post-ablation reentrant atrial tachycardia had a greater incidence of gaps in the LA appendage ridge, whereas focal atrial tachycardia had a higher incidence of gaps in the PV carina. 30 Those reentrant tachycardias frequently terminated during mitral and roof linear ablation. 29,30 An excellent outcome with only a 0.6% recurrence was demonstrated during a 21-month follow-up.…”

Section: Prevention Of Gap Formation and Activation Mapping To Guide mentioning

confidence: 99%

Three-Dimensional Electroanatomic Mapping Systems in Catheter Ablation of Atrial Fibrillation

Chen

2010

Circ J

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Atrial fibrillation (AF) is the most common tachyarrhythmia, with a prevalence of 5% in people over the age of 65. Catheter ablation of AF has emerged as an important management choice for drug-refractory symptomatic paroxysmal or persistent AF. Three-dimensional (3D) electroanatomic mapping systems were introduced into catheter ablation of AF more than a decade ago. The 3D tool has the benefit of reducing the radiation exposure time, as well as voltage and fractionation mapping in order to identify the critical substrate during the ablation, prevent the formation of gaps, guide the ablation of post-ablation atrial tachycardia or flutter, and integrate images to improve the safety and long-term success rate. The 3D systems successfully enable safe and tailored radiofrequency ablation of AF in individual patients. (Circ J 2010; 74: 18 - 23)

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Left atrial thickness under the catheter ablation lines in patients with paroxysmal atrial fibrillation: insights from 64-slice multidetector computed tomography

et al. 2012

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A detailed understanding of the left atrial (LA) anatomy in patients with atrial fibrillation (AF) would improve the safety and efficacy of the radiofrequency catheter ablation. The objective of this study was to examine the myocardial thickness under the lines of the circumferential pulmonary vein isolation (CPVI) using 64-slice multidetector computed tomography (MDCT). Fifty-four consecutive symptomatic drug-refractory paroxysmal AF patients (45 men, age 61 ± 12 years) who underwent a primary CPVI guided by a three-dimensional electroanatomic mapping system (Carto XP; Biosense-Webster, Diamond Bar, CA, USA) with CT integration (Cartomerge; Biosense-Webster) were enrolled. Using MDCT, we examined the myocardial thickness of the LA and pulmonary vein (PV) regions in all patients. An analysis of the measurements by the MDCT revealed that the LA wall was thickest in the left lateral ridge (LLR; 4.42 ± 1.28 mm) and thinnest in the left inferior pulmonary vein wall (1.68 ± 0.27 mm). On the other hand, the thickness of the posterior wall in the cases with contact between the esophagus and left PV antrum was 1.79 ± 0.22 mm (n = 30). After the primary CPVI, the freedom from AF without any drugs during a 1-year follow-up period was 78 % (n = 42). According to the multivariate analysis, the thickness of the LLR was an independent positive predictor of an AF recurrence (P = 0.041). The structure of the left atrium and PVs exhibited a variety of myocardial thicknesses in the different regions. Of those, only the measurement of the LLR thickness was associated with an AF recurrence.

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Induced Atrial Tachycardia After Circumferential Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation: Electrophysiological Characteristics and Impact of Catheter Ablation on the Follow‐Up Results

Abstract: The location of the AT gap may be related with the complex anatomy of the LA. The induced ATs after CPVI can be eliminated by catheter ablation.

Cited by 51 publications

References 28 publications

Electrophysiological Features of Atrial Tachyarrhythmias After the Creation of a Left Atrial Roof Line During Catheter Ablation of Atrial Fibrillation

Electrophysiological Features of Atrial Tachyarrhythmias After the Creation of a Left Atrial Roof Line During Catheter Ablation of Atrial Fibrillation

Three-Dimensional Electroanatomic Mapping Systems in Catheter Ablation of Atrial Fibrillation

Left atrial thickness under the catheter ablation lines in patients with paroxysmal atrial fibrillation: insights from 64-slice multidetector computed tomography

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