title: Clinical significance of induced left atrial macro-reentrant tachycardia after pulmonary vein isolation.
abstract: BACKGROUND
  The clinical significance of induced left atrial macro-reentrant tachycardia (LA-AT) after encircling pulmonary vein isolation (EPVI) is unclear. Our objective was to determine whether induced LA-ATs are associated with the clinical recurrence of ATs.
  
  
  METHODS
  We studied 185 consecutive patients with paroxysmal atrial fibrillation (PAF) who underwent their first EPVI with an 8-mm tip, nonirrigated catheter approach. AT was induced by atrial burst pacing after the completion of EPVI, and the atrial activation pattern was evaluated using EnSite NavX. Induced LA-ATs were ablated only in patients with clinical ATs of suspected LA origin. The factors associated with occurrence of AT after the procedure were examined.
  
  
  RESULTS
  LA-ATs were induced in 38 patients and ablated in 5 patients. During a follow-up of 23 ± 7 months, the occurrence of AT did not differ between patients with nonablated LA-ATs (4/33, 12 %) and those without any inducible ATs (16/113, 14 %, p > 0.99). In multivariate analysis, the number of ablation points for completing EPVI was the only independent predictor of AT occurrence (odds ratio 1.07, p < 0.01). A repeat procedure was performed in 22 of 26 patients who developed AT. Nineteen patients became free from AT and AF after ablation of the conduction gaps (EPVI, n = 17; another line, n = 4), extra PV firing (n = 4), focal AT (n = 4), and induced LA-ATs (n = 3).
  
  
  CONCLUSIONS
  In patients who had EPVI for PAF using an 8-mm tip, nonirrigated catheter, the occurrence of AT after EPVI was mainly due to conduction gaps in the ablation line or extra PV triggers. In patients with PAF, LA-ATs induced during the first procedure did not require ablation if they were not associated with clinical AT.
authors.affiliation: Department of Cardiology, Saiseikai Izuo Hospital, Kitamura 3-4-5, 551-0032, Taisho-ku, Osaka, Japan. hideyuki@med.kitasato-u.ac.jp.|Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan. hideyuki@med.kitasato-u.ac.jp.
authors.forename: Hideyuki
authors.identifier: http://orcid.org/0000-0002-0629-2927
authors.initials: H
authors.lastname: Hara
authors.affiliation: Department of Cardiology, Saiseikai Izuo Hospital, Kitamura 3-4-5, 551-0032, Taisho-ku, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshinaga
authors.affiliation: Department of Cardiology, Saiseikai Izuo Hospital, Kitamura 3-4-5, 551-0032, Taisho-ku, Osaka, Japan.
authors.forename: Yumie
authors.initials: Y
authors.lastname: Matsui
authors.affiliation: Department of Cardiology, Saiseikai Izuo Hospital, Kitamura 3-4-5, 551-0032, Taisho-ku, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiology, Saiseikai Izuo Hospital, Kitamura 3-4-5, 551-0032, Taisho-ku, Osaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ishido
authors.affiliation: Department of Cardiology, Saiseikai Izuo Hospital, Kitamura 3-4-5, 551-0032, Taisho-ku, Osaka, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yutaka
authors.affiliation: Nihon Kohden, Co., Ltd., Tokyo, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kasuu
authors.affiliation: Department of Cardiology, Saiseikai Izuo Hospital, Kitamura 3-4-5, 551-0032, Taisho-ku, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Karakawa
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D011667:Pulmonary Veins / Q000601:surgery*; D012307:Risk Factors; D013615:Tachycardia, Sinoatrial Nodal Reentry / Q000175:diagnosis / Q000453:epidemiology*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Atrial tachycardia; Pulmonary vein isolation