ATRIAL FIBRILLATION
Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation
Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Lazarettstrasse 36 D-80636 München, Germany
Aims To investigate the incidence, electrophysiological properties, and ablation results for left atrial (LA) tachycardia as a sequel to the circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF).
Methods and results Sixty-seven patients with AF underwent CPVA. Sustained LA tachycardia developed in 21/67 (31%) patients and in 16/21 symptomatic patients 55 LA tachycardias (3.4±2.4 per patient) were mapped: 18 (33%) tachycardias were related to macro-re-entry around the mitral valve (7) or pulmonary vein(s) (11). In 20 tachycardias (36%), a ‘small-loop’ LA re-entrant tachycardia (LART) was identified; gaps in prior ablation lines (7 LART) or an area of extremely slow conduction adjacent to the CPVA lesions (13 LART) were crucial for these re-entries. Seventeen tachycardias (31%) were too unstable for complete mapping. Ablation was a primary success in 34 of 38 (89%) mapped LART, but in eight of 21 procedures, cardioversion was necessary to achieve sinus rhythm.
Conclusion LART develops in a high percentage of patients after CPVA. Small-loop re-entry, which is difficult to map, may arise and patients suffer from several and/or unstable variants of LART. Thus, mapping and ablation of these LART is challenging and the overall success is yet not satisfactory.
Key Words: Circumferential pulmonary vein ablation, Atrial fibrillation, Left atrial tachycardia, Proarrhythmia, Re-entry, Small-loop
* Corresponding author. Tel: +49 89 1218 2020; fax: +49 89 12184593. E-mail address: deisenhofer{at}dhm.mhn.de
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. M. Patel, A. d'Avila, P. Neuzil, S. J. Kim, MSEE, T. Mela, J. P. Singh, J. N. Ruskin, and V. Y. Reddy Atrial Tachycardia After Ablation of Persistent Atrial Fibrillation: Identification of the Critical Isthmus With a Combination of Multielectrode Activation Mapping and Targeted Entrainment Mapping Circ Arrhythmia Electrophysiol, April 1, 2008; 1(1): 14 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Moreira, R. Manusama, C. Timmermans, B. Ghaye, S. Philippens, H. J.J. Wellens, and L.-M. Rodriguez Long-Term Follow-Up After Cryothermic Ostial Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation J. Am. Coll. Cardiol., February 26, 2008; 51(8): 850 - 855. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. D. Callahan and A. Natale Procedural End Points in Pulmonary Vein Antrum Isolation: Are We There Yet? Circulation, January 15, 2008; 117(2): 131 - 133. [Full Text] [PDF]
|
|
|
|
|
|
J. P. Daubert Iatrogenic Left Atrial Tachycardias: Where Are We? J. Am. Coll. Cardiol., October 30, 2007; 50(18): 1788 - 1790. [Full Text] [PDF]
|
|
|
|
|
|
M. D. O'Neill, P. Jais, M. Hocini, F. Sacher, G. J. Klein, J. Clementy, and M. Haissaguerre Catheter Ablation for Atrial Fibrillation Circulation, September 25, 2007; 116(13): 1515 - 1523. [Full Text] [PDF]
|
|