title: Occurrence of Focal Atrial Tachycardia During the Ablation Procedure Is Associated With Arrhythmia Recurrence After Termination of Persistent Atrial Fibrillation.
abstract: BACKGROUND
  Catheter ablation can terminate persistent atrial fibrillation (AF). However, atrial tachycardia (AT) often arises after termination of AF.
  
  
  RESULTS
  Of 215 patients who underwent index stepwise ablation for persistent AF, 141 (66%) patients (64 ± 9 years) in whom AF terminated during the ablation procedure were studied. If AF converted into AT, ablation for AT was subsequently performed. ATs were categorized as focal or macroreentrant AT. We assessed whether type of AT occurring after conversion of AF during the ablation procedure was associated with freedom from atrial tachyarrhythmia (AF or AT) during follow-up. Sinus rhythm was directly restored from AF in 37 patients, while 34, 37, and 33 patients had focal AT alone, a mix of focal and macroreentrant AT, and macroreentrant AT alone after termination of AF, respectively. Arrhythmia-free survival rates at 1 year after the index procedure were 30%, 34%, 61%, and 59% in the patients with focal AT alone, a mix of focal AT and macroreentrant AT, macroreentrant AT alone, and direct restoration of sinus rhythm, respectively (P = 0.004). Type of AT occurring during the index procedure was associated with type of recurrent AT (P = 0.03), but the origin of focal AT occurring during the index ablation differed from that of the recurrent AT in 85% of patients.
  
  
  CONCLUSIONS
  In patients who had AF termination by ablation, occurrence of focal AT during the ablation procedure was associated with worse clinical outcome than occurrence of macroreentrant AT, likely due to ATs arising from other foci during follow-up.
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.|Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Iwai
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Masumura
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Syu
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Doi
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakakibara
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Nomoto
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Oumi
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ohno
authors.affiliation: Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: catheter ablation; focal atrial tachycardia; macroreentrant atrial tachycardia; persistent atrial fibrillation; stepwise ablation