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

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). Sixty-seven patients with AF underwent CPVA. Sustained LA tachycardia developed in 21/6...

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Bibliographic Details
Published in:Europace (London, England) England), 2006-08, Vol.8 (8), p.573-582
Main Authors: Deisenhofer, Isabel, Estner, Heidi, Zrenner, Bernhard, Schreieck, Juergen, Weyerbrock, Sonja, Hessling, Gabriele, Scharf, Konstanze, Karch, Martin R, Schmitt, Claus
Format: Article
Language:English
Subjects:
Aged
Atrial Fibrillation - physiopathology
Atrial Fibrillation - surgery
Catheter Ablation - adverse effects
Catheter Ablation - methods
Electrocardiography
Electrophysiology
Female
Heart Conduction System - physiopathology
Humans
Incidence
Male
Middle Aged
Prospective Studies
Pulmonary Veins - surgery
Tachycardia, Ectopic Atrial - etiology
Tachycardia, Ectopic Atrial - physiopathology
Treatment Outcome
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Summary: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). 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. 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.
ISSN:1099-5129
1532-2092
DOI:10.1093/europace/eul077