Ablation of left atrial tachycardia with cycle length alternans after atrial fibrillation ablation: significance of fractionated electrogram mapping

Abstract Introduction Atrial tachycardia (AT) with cycle length alternans occurring after atrial fibrillation ablation has not been previously described. Methods Among 66 patients with left AT, stable AT with 2 alternating cycles was registered in 5 cases. Activation mapping of both alternating cycl...

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Bibliographic Details
Published in:Journal of electrocardiology 2011-03, Vol.44 (2), p.164-170
Main Authors: Mikhaylov, Evgeny, MD, Szili-Torok, Tamas, MD, PhD, Abramov, Mikhail, MD, Lebedev, Dmitry, MD, PhD
Format: Article
Language:English
Subjects:
Atrial fibrillation
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - surgery
Atrial tachycardia
Body Surface Potential Mapping - methods
Cardiovascular
Catheter ablation
Catheter Ablation - methods
Electroanatomical mapping
Female
Fractionated electrogram
Humans
Left atrium
Male
Middle Aged
Surgery, Computer-Assisted - methods
Tachycardia, Ectopic Atrial - diagnosis
Tachycardia, Ectopic Atrial - etiology
Tachycardia, Ectopic Atrial - prevention & control
Treatment Outcome
Unmappable tachycardia
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Summary:Abstract Introduction Atrial tachycardia (AT) with cycle length alternans occurring after atrial fibrillation ablation has not been previously described. Methods Among 66 patients with left AT, stable AT with 2 alternating cycles was registered in 5 cases. Activation mapping of both alternating cycles was performed in all 5 patients. Entrainment and fractionated electrogram mappings were also carried out. Results Among 10 AT cycles, activation maps suggested underlying mechanism of 5 cycles (50%) in 3 patients. Entrainment pacing was helpful in 2 patients (confirmed mechanism of 2 AT cycles). Catheter ablation successfully terminated AT in all 5 patients: ablation of sites with fractionated potentials in 4 patients and mitral isthmus ablation in 1 patient. Conclusion Consecutive activation mapping of both AT cycles is feasible for mechanism determination in some patients. The results of our small study suggest that fractionated electrogram–guided ablation might be a reasonable approach for termination of this type of AT.
ISSN:0022-0736
1532-8430
DOI:10.1016/j.jelectrocard.2010.11.002