title: Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation.
abstract: OBJECTIVE
  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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Lazarettstrasse 36 D-80636 München, Germany. deisenhofer@dhm.mhn.de
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
authors.forename: Heidi
authors.initials: H
authors.lastname: Estner
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zrenner
authors.forename: Juergen
authors.initials: J
authors.lastname: Schreieck
authors.forename: Sonja
authors.initials: S
authors.lastname: Weyerbrock
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
authors.forename: Konstanze
authors.initials: K
authors.lastname: Scharf
authors.forename: Martin R
authors.initials: MR
authors.lastname: Karch
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D013612:Tachycardia, Ectopic Atrial / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome