Journal
EUROPACE
Volume 8, Issue 8, Pages 573-582Publisher
OXFORD UNIV PRESS
DOI: 10.1093/europace/eul077
Keywords
circumferential pulmonary vein ablation; atrial fibrillation; left atrial tachycardia; proarrhythmia; re-entry; small-loop
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Aims To investigate the incidence, electrophysiological properties, and ablation results for left atrial (LA) tachycardia as a sequel to the circumferential pulmonary vein ablation (CPVA) for atrial, fibrillation (AF). Methods and results Sixty-seven patients with AF underwent CPVA. Sustained LA tachycardia developed in 21/67 (31%) patients and in 16/21 symptomatic patients 55 LA tachycardias (3.4 +/- 2.4 per patient) were mapped: 18 (33%) tachycardias were related to macro-re-entry around the mitral valve (7) or pulmonary vein(s) (11). In 20 tachycardias (36%), a 'small-loop' LA re-entrant tachycardia (LART) was identified; gaps in prior ablation lines (7 LART) or an area of extremely stow conduction adjacent to the CPVA lesions (13 LART) were crucial for these re-entries. Seventeen tachycardias (31%) were too unstable for complete mapping. Ablation was a primary success in 34 of 38 (89%) mapped LART, but in eight of 21 procedures, cardioversion was necessary to achieve sinus rhythm. Conclusion LART develops in a high percentage of patients after CPVA. Small-loop re-entry, which is difficult to map, may arise and patients suffer from several and/or unstable variants of LART. Thus, mapping and ablation of these LART is challenging and the overall success is yet not satisfactory.
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