Prevalence and predictive factors of left atrial tachycardia occurring after second‐generation cryoballoon ablation of atrial fibrillation

Abstract

Introduction: Assess the prevalence and predictors of left atrial tachycardia (LAT) after cryoballoon ablation of pulmonary veins. Methods and results:Patients who underwent catheter ablation of pulmonary veins with a second-generation cryoballoon for symptomatic paroxysmal (151 of 270, 56%) or persistent (119 of 270, 44%) atrial fibrillation were entered in a single-center prospective registry. Patients who experienced postcryoballoon LAT (pcryo-LAT) were selected on the basis of 12-lead ECG characteristics. Left atrial origin was confirmed during conventional EP study and electroanatomical activation mapping, and patients were treated by RF catheter ablation.Pcryo-LAT was observed in 15 (5.6%) of 270 patients and was attributed to a reentrant mechanism in 11 patients (73%). The other four cases of pcryo-LAT were due to focal atrial tachycardia associated with reconnection of one pulmonary vein. In comparison with patients who remained in sinus rhythm, LA area (HR = 1.09; CI 1.01, 1.2; P = 0.02), LVEF (HR = 0.94; CI 0.90, 0.97; P < 0.001), and LVEF <50% (HR = 8.5; CI 3.1, 23.6; P < 0.001) were predictors of pcryo-LAT. After multivariate Cox analysis, only left ventricular ejection fraction < 50% remained predictive of pcryo-LAT, (HR = 7.8, CI 2.3 26.7, P = 0.002). With a mean survival of 23 months, 73% of patients who experienced pcryo-LAT were in sinus rhythm versus 78% of patients without pcryo-LAT (log rank P = 0.85). Conclusion:The prevalence of pcryo-LAT in patients with atrial fibrillation is low. Left ventricular ejection fraction < 50% is associated with an increased risk of pcryo-LAT. When treated by RF catheter ablation, the presence of pcryo-LAT is not a predictive factor of subsequent recurrence of atrial fibrillation during follow-up.

Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current

“…The occurrence of atrial tachycardias after stand‐alone PVI without substrate modification is a known but less frequent finding during reablation, with incidences between 2.8% and 11.3% 5,6,19‐21 . Several small studies comparing ATs after stand‐alone RFC or CB PVI have been conducted, and the results are very heterogeneous 5,6,19‐23 .…”

“…The occurrence of atrial tachycardias after stand‐alone PVI without substrate modification is a known but less frequent finding during reablation, with incidences between 2.8% and 11.3% 5,6,19‐21 . Several small studies comparing ATs after stand‐alone RFC or CB PVI have been conducted, and the results are very heterogeneous 5,6,19‐23 . Interestingly, the findings are divergent, varying from studies that describe only PV‐dependent, focal AT 22,23 to a study from Lyan et al 5 that reports only left atrial macroreentries after CB PVI without any PV association in the AT mechanism.…”

“…Different gap patterns have been described after index PVI with RFC versus CB 3,4 . A less‐common but clinically relevant finding is the occurrence of atrial tachycardia (AT) after stand‐alone PVI without prior substrate modification 5,6 …”

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

“…Subsequent ATs are less common after pulmonary vein isolation (approximately 5% incidence) compared with patients treated with linear lesions and ablation of complex electrograms (about 25%). [15–18] While macro-reentrant arrhythmias are the most common form of AT following AF ablation, focal arrhythmias also occur in a minority of such patients.…”

Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation

“…In the enclosed report, we aim to investigate the incidence of and risk factors for post-CBA-PVI atrial flutter and their anatomic location. Although previous studies have looked at the rates of recurrence of atrial tachyarrhythmias-including atrial fibrillation, atrial flutter, and atrial tachycardia-seldom have previous studies systematically examined the rates of atrial flutter, specifically, and characterized clinical risk factors and anatomic locations among the CBA-PVI population over long-term follow-up [3,10,11].…”