title: Catheter ablation of scar-related atypical atrial flutter.
abstract: OBJECTIVE
  The aim of the study was to assess the impact of isthmus location of atypical atrial flutters/atrial tachycardias (ATs) on outcomes of catheter ablation. Atrial tachycardias are clinically challenging arrhythmias that can occur in the presence of atrial scar--often due to either cardiac surgery or prior ablation for atrial fibrillation. We previously demonstrated a catheter ablation approach employing rapid multielectrode activation mapping with targeted entrainment manoeuvrs. However, the role that AT isthmus location plays in acute and long-term success of ablation remains uncertain.
  
  
  RESULTS
  Retrospective multicenter analysis of 91 consecutive AT patients undergoing ablation using a systematic four-step approach: (i) high-density activation mapping; (ii) analysis of atrial activation to identify wavefronts of electrical propagation; (iii) targeted entrainment of putative channels; and (iv) irrigated radiofrequency ablation of constrained regions of the circuit. Clinical outcomes, procedural details, and clinical profiles were determined. A total of 171 ATs (1.9 ± 1.0 per patient, 26% septal ATs) were targeted for ablation. The acute success rates were 97 and 77% for patients with either non-septal ATs or septal ATs, respectively (P = 0.0023). Similarly, the long-term success rates were 82 and 67% for patients with either no septal ATs or at least one septal AT, respectively (P = 0.1057). The long-term success rates were 75, 88, and 57% for patients with ATs associated with prior catheter ablation, cardiac surgery or MAZE, and idiopathic atrial scar, respectively.
  
  
  CONCLUSIONS
  Catheter ablation of AT can be successfully performed employing a strategy of combined high-density activation and entrainment mapping. Septal ATs are associated with higher rates of acute and long-term recurrences.
authors: Helmsley Electrophysiology Center,  Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York City, NY 10029,  USA.
authors: James O
authors: JO
authors: Coffey
authors: Andre
authors: A
authors: d'Avila
authors: Srinivas
authors: S
authors: Dukkipati
authors: Stephan B
authors: SB
authors: Danik
authors: Sandeep R
authors: SR
authors: Gangireddy
authors: Jacob S
authors: JS
authors: Koruth
authors: Marc A
authors: MA
authors: Miller
authors: Solomon J
authors: SJ
authors: Sager
authors: Charles A
authors: CA
authors: Eggert
authors: Vivek Y
authors: VY
authors: Reddy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D002921:Cicatrix / Q000150:complications*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult