Stepwise Approach to Management of Atrial Arrhythmias after Catheter Ablation of Atrial Fibrillation

Abstract

Pulmonary vein (PV) isolation and different left atrial ablation strategies proved to be curative for patients with paroxysmal and persistent atrial fibrillation (AF). However the ablation lesions in the left atrium could lead to iatrogenic left atrial tachycardias (ATs) which is observed in up to 40% of patients with previous AF ablation. Nearly one-third of the recurrent ATs after AF ablation disappear spontaneously; however, the majority of these patients will need a repeated ablation procedure as antiarrhythmic medications tend to be less effective in such patients. Understanding the previous ablation lines is of critical importance for the subsequent ablation strategy. In most cases, mapping and re-isolation of all PVs should be the first step approaching the left ATs. In this chapter we describe a deductive stepwise strategy which will help to successfully ablate these ATs with favorable long-term results.