Journal Article

Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation

Isabel Deisenhofer, Heidi Estner, Bernhard Zrenner, Juergen Schreieck, Sonja Weyerbrock, Gabriele Hessling, Konstanze Scharf, Martin R. Karch and Claus Schmitt

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 8, issue 8, pages 573-582
Published in print August 2006 | ISSN: 1099-5129
Published online August 2006 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eul077
Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation

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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.

Keywords: Circumferential pulmonary vein ablation; Atrial fibrillation; Left atrial tachycardia; Proarrhythmia; Re-entry; Small-loop

Journal Article.  4747 words.  Illustrated.

Subjects: Cardiovascular Medicine

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