Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…The incidence of AFL after AF ablation depends on the type of ablation performed during the initial procedure, varying from 2.6% in centers performing PVI alone to 31% in centers performing linear ablation. 622,623,624,625 AFL is less common after PVI with CB compared with RF-based PVI. 489 The mechanism of AFL is reentry.…”

“…253,436,507,508,622,623, 624,625,630,870,871,995,996,997,998,999,1000,1001,1002 Most of these tachycardias originate in the LA, although RA cavotricuspid isthmus (CTI)-dependent flutters might also occur. Patients with a regular AT of new onset might complain of worsening symptoms due to a faster mean ventricular rate (frequently 2:1 ventricular response) than that during AF preablation.…”

“…For those with intolerable symptoms or continued late AT recurrence, detailed activation and entrainment mapping of the tachycardia results in effective ablation in approximately 90% of patients. 447,622,623,624,1006,1007,1008 …”

Characterization of Left Atrial Tachyarrhythmias in Patients Following Atrial Fibrillation Ablation: Correlation of surface ECG with Intracardiac Mapping

“…[5][6][7][8][9][10] The mechanism(s) underlying development of organized atrial tachyarrhythmias in these patients as reported by various investigators remains inconsistent. One reason for this inconsistency is the use of terms atrial tachycardia (AT) and flutter interchangeably to describe these arrhythmias.…”

“…An interesting observation in this context is that centers utilizing wide area circumferential PV ablation without necessarily confirming isolation report a higher prevalence (10-24%) of macro-reentrant atypical LA flutters. 2,5,9 In contrast centers that utilize PV isolation alone have observed a low overall incidence of organized atrial tachycarrhythmias and these have predominantly been focal, originating from in and around the reconnected PV segments. 1,7,8,11 In a prospective randomized comparison of segmental PV isolation versus wide area circumferential anatomical PV ablation, Karch et al reported a significantly higher occurrence of organized atrial tacycardias in the latter group (18% versus 2%).…”