title: Recurrent spontaneous clinical perimitral atrial tachycardia in the context of atrial fibrillation ablation.
abstract: BACKGROUND
  Recurrent perimitral atrial tachycardia (AT) is a challenging arrhythmia and is frequently encountered in the context of atrial fibrillation (AF) ablation.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the clinical characteristics and the procedural and clinical outcomes in patients with recurrent perimitral atrial tachycardia (PMAT) after AF ablation.
  
  
  METHODS
  Among 520 consecutive ablation procedures for recurrent AT/AF after AF ablation, 40 procedures (patients) were performed for clinically recurrent PMAT 12.1 ± 13.6 months after the last procedure (total 2.2 ± 1.3 procedures). Previously, mitral isthmus (MI) linear ablation was performed in 26 of 40 procedures, including 13 procedures with complete block and 13 with 159.0 ± 23.0 ms of conduction delay without block. As a reference group, conduction delay was evaluated in 55 patients with incomplete MI block and absence of spontaneous PMAT during the follow-up period.
  
  
  RESULTS
  Recurrent PMATs were terminated by MI linear ablation in 26 of 40 patients. Bidirectional block across the MI and anterior line joining the mitral annulus and left atrial roof was achieved in 33 (82.5%) and 2 (5%) patients, respectively. At mean follow-up of 26.7 ± 14.5 months, 2 patients (5%) underwent reablation for spontaneously recurrent PMAT. At 12 months after the ablation procedure for PMAT, 73.5% of the patients were free from AT/AF. Conduction delay >149 ms predicted the occurrence of spontaneous PMAT with 80.0% sensitivity and 87.3% specificity.
  
  
  CONCLUSIONS
  PMAT can recur even after successful bidirectional MI linear block. Substantial conduction delay without block across the MI from a previous procedure(s) could predispose to recurrent PMAT. Although most clinical PMATs can be successfully treated by catheter ablation, very late recurrence is possible.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France. Electronic address: mshinsuke@k3.dion.ne.jp.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Shah
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Linear ablation; Mitral isthmus