Tachycardia transition during ablation of persistent atrial fibrillation.
BACKGROUND
The "sequential ablation" strategy for persistent AF is aimed at progressive organization of AF until the rhythm converts to sinus rhythm or atrial tachycardia (AT). During ablation of an AT, apparently seamless transitions from one organized AT to another occur. The purpose of our study was to quantify the occurrence and the mechanism of this transition.


RESULTS
Twenty-nine of 90 patients undergoing ablation for persistent AF had multiple AT during the procedure and constitute the study group. Thirty-nine direct transitions from one AT to another during ablation were observed classified in four types: type I (79.4%), i.e., a direct transition of a faster to a slower tachycardia without significant intervening pause; type II (7.69%)--transition after intervening ectopy or longer pause; type III (10.26%)--A slower AT accelerated; type IV (2.56%)--alteration of activation sequence but with no change on CL.


CONCLUSIONS
Transition to a second AT occurs frequently in the midst of ablation of AT in persistent AF patients. This transition occurs most commonly abruptly within the range of a single cycle length of the original AT. This is best explained by a continuation of AT that was "present" simultaneously with the pretransition tachycardia, being "entrained" (for a reentrant tachycardia) or "overdriven" for an automatic focal tachycardia. The presence of multiple tachycardia mechanisms active simultaneously would be consistent with the eclectic pathophysiology of persistent AF.
Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France. leonardoarantesdoc@terra.com.br
Leonardo
L
Arantes
George J
GJ
Klein
Pierre
P
Jaïs
Kang-Teng
KT
Lim
Seiichiro
S
Matsuo
Sébastien
S
Knecht
Mélèze
M
Hocini
Mark D
MD
O'Neill
Jacques
J
Clémenty
Michel
M
Haïssaguerre
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D002908:Chronic Disease; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D014693:Ventricular Fibrillation / Q000453:epidemiology* / Q000517:prevention & control