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Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation.
MedLine Citation:
PMID:  22683745     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Antral pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF) may induce left atrial tachycardias (AT). OBJECTIVE: The purpose of this study was to determine the prevalence, time course of occurrence, mechanisms and correlation with the electrocardiogram (ECG) as well as outcome of ablation of these tachycardias. METHODS AND RESULTS: Out of 839 patients who underwent circumferential antral radiofrequency PVI isolation guided by a circumferential PV catheter at our institution between February 2005 and April 2011, 35 patients (4%) developed AT during follow-up. Six patients with left AT and a previous PVI at other institutions were also included. Of these 41 patients (26 men, 63%; age 59±10 years), 26 (63%) had underlying paroxysmal AF and 15 (37%) had persistent AF. AT ablation was performed 47±60 weeks after initial PVI, within the first three months in 16 patients (39%). The tachycardia mechanism was focal in 15 patients (37%), macro-reentry in 25 patients (61%) and undetermined in one (2%). Focal tachycardias had an isoelectric line between distinct P waves in 13 of 15 patients (87%), while only four (16%) with a macro-reentrant mechanism had an isoelectric line (p<0.001). Although difficult to measure, a P wave width of > 140ms had the highest sensitivity and specificity to identify macro-reentrant mechanism. Ablation was acutely successful in 32 patients (78%) and not successful in four (10%). In five patients success could not be determined as the tachycardia terminated or degenerated during mapping. During a mean follow-up of 31±17 months 11 patients (27%; n=9 (82%) with macro-reentry) underwent repeat ablation procedure for AT. Eight patients had true recurrence e.g. the same AT and three patients had a second mechanism of AT. CONCLUSION: Using an identical ablation protocol, approximately 4% of patients developed AT after mere circumferential antral PVI. The majority of AT developed within a few months after ablation but occurred as late as several years after the initial PVI. Macro-reentry was more frequent than a focal mechanism. Broad P waves and isoelectric lines between P waves help to distinguish a focal from a macro-reentrant mechanism. Ablation has a high acute success rate and AT recurrence occurs predominantly in macro-reentrant AT.
Authors:
Kristina Wasmer; Gerold Mönnig; Alex Bittner; Dirk Dechering; Stephan Zellerhoff; Peter Milberg; Julia Köbe; Lars Eckardt
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-5
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
Division of Experimental and Clinical Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Germany.
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