Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique.
BACKGROUND
Atrial tachyarrhythmias (ATa) can recur after continuous circular lesions (CCLs) around the ipsilateral pulmonary veins (PVs) in patients with atrial fibrillation (AF). This study characterizes the electrophysiological findings in patients with and without ATa after complete PV isolation.


RESULTS
Twenty-nine of 100 patients had recurrent ATa after complete PV isolation by use of CCLs during a mean follow-up of approximately 8 months. A repeat procedure was performed in 26 patients with ATa and in 7 volunteers without ATa at 3 to 4 months after CCLs. No recovered PV conduction was demonstrated in the 7 volunteers, whereas recovered PV conduction was found in 21 patients with recurrent ATa (right-sided PVs in 9 patients and left-sided PVs in 16 patients). The interval from the onset of the P wave to the earliest PV spike was 157+/-66 ms in the right-sided PVs and 149+/-45 ms in the left-sided PVs. During the procedure, PV tachycardia activated the atrium and resulted in atrial tachycardia (AT) in 10 patients. All conduction gaps were successfully closed with segmental RF ablation. After PV isolation, macroreentrant AT was induced and ablated in 3 patients. In the 5 patients without PV conduction, focal AT in the left atrial roof in 2 patients and non-PV foci in the left atrium in 1 patient were successfully abolished; in the remaining 2 patients, no ablation was performed because of noninducible arrhythmias. During a mean follow-up of approximately 6 months, 24 patients were free of ATa without antiarrhythmic drugs.


CONCLUSIONS
In patients with recurrent ATa after CCLs, recovered PV conduction is a dominant finding in approximately 80% of patients and can be successfully eliminated by segmental RF ablation. Also, mapping and ablation of non-PV arrhythmias can improve clinical success.
Ouyang
Feifan
F
II. Medizinische Abteilung, Allgemeines Krankenhaus St Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany. ouyangfeifan@aol.com
Antz
Matthias
M
Ernst
Sabine
S
Hachiya
Hitoshi
H
Mavrakis
Hercules
H
Deger
Florian T
FT
Schaumann
Anselm
A
Chun
Julian
J
Falk
Peter
P
Hennig
Detlef
D
Liu
Xingpeng
X
Bänsch
Dietmar
D
Kuck
Karl-Heinz
KH
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002828:Choristoma / Q000503:physiopathology; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D032383:Myocytes, Cardiac / Q000502:physiology; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012038:Regeneration; D012086:Reoperation; D013612:Tachycardia, Ectopic Atrial / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants