Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation: mechanistic insights, results of catheter ablation, and risk factors for recurrence.
OBJECTIVE
The aim of this study was to determine the mechanism of atrial tachycardia (AT) that occurs after ablation of atrial fibrillation (AF).


BACKGROUND
Patients who undergo catheter ablation of AF may develop AT during follow-up.


METHODS
Seventy-eight patients underwent an ablation procedure for AT after circumferential pulmonary vein ablation (CPVA) for AF. The 3-dimensional maps from the AF and AT procedures were compared to determine whether AT arose from a prior ablation line.


RESULTS
A total of 155 ATs were mapped, and the mechanism was re-entry in 137 (88%) and focal in 18 (12%). The most common left atrial (LA) ablation targets were the mitral isthmus, roof, and septum. The critical isthmus in 115 of the 120 LA re-entrant ATs (96%) traversed a prior ablation line, consistent with a gap-related mechanism. Catheter ablation was successful in 66 of the 78 patients (85%). After a mean follow-up of 13 +/- 10 months, 60 of the 78 patients (77%) were free of AT/AF without antiarrhythmic medications. Re-entrant septal AT was associated with recurrence (odds ratio 7.3; 95% confidence interval 1.5 to 36; p = 0.02), whereas PV isolation during the AT procedure was associated with a favorable outcome (odds ratio 0.17; 95% confidence interval 0.04 to 0.81; p = 0.03).


CONCLUSIONS
Approximately 90% of ATs after CPVA are re-entrant, and nearly all are related to gaps in prior ablation lines. These findings suggest that the prevalence of these arrhythmias may be reduced by limiting the number of linear lesions, demonstration of linear block, and pulmonary vein disconnection during the initial AF procedure.
Chae
Sanders
S
Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA.
Oral
Hakan
H
Good
Eric
E
Dey
Sujoya
S
Wimmer
Alan
A
Crawford
Thomas
T
Wells
Darryl
D
Sarrazin
Jean-Francois
JF
Chalfoun
Nagib
N
Kuhne
Michael
M
Fortino
Jackie
J
Huether
Elizabeth
E
Lemerand
Tammy
T
Pelosi
Frank
F
Bogun
Frank
F
Morady
Fred
F
Chugh
Aman
A
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013612:Tachycardia, Ectopic Atrial / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome