Catheter ablation of left atrial tachycardia using individualized strategies achieved 82% freedom from any atrial tachycardia and 77% freedom from any arrhythmia at 12 months.
Cohort (n=35)
Does catheter ablation using predefined individual strategies improve freedom from atrial tachycardia in patients with left atrial tachycardia following previous AF ablation?
Individualized catheter ablation strategies based on reentry mechanisms and critical isthmuses yield high acute termination rates and an 82% freedom from atrial tachycardia at 12 months in patients with post-AF ablation left atrial tachycardia.
The treatment of atrial tachycardia following catheter ablation of atrial fibrillation is often challenging. Electrophysiological studies using high-resolution 3D mapping systems have contributed significantly to their understanding, and new ablation approaches have shown high rates of acute terminations with low recurrences for the clinical AT. However, patient populations are very heterogeneous, and long-term data of the freedom from any atrial tachycardia or any arrhythmia are still sparse. To evaluate long-term success, a unified patient population and predefined ablation strategies are preferred. In this study, we present 12-month success and mean 30 month follow-up data of catheter ablation of left atrial tachycardia. All 35 patients had a history of pulmonary vein isolation (PVI), 71% of which had a previous substrate modification. A total of 54 ATs, with a mean cycle length 297 ± 86 ms, 31 macro-reentries, and 4 localized reentries, were targeted. The ablation strategy to be used was given by the study protocol, depending on the type of reentry and the number of critical isthmuses. All available ablation strategies were included: standard (anatomical) lines, individual lines, critical isthmuses, and focal ablation. All ATs were terminated by ablation. A total of 91% terminated upon the first ablation strategy. Freedom from any AT after 12 months was 82%, and from any arrhythmia, it was 77%. The multi-procedure success after 30 months was 65% for any AT and 55% for any arrhythmia. In conclusion, individual ablation strategies based on the reentry mechanism and the number of critical isthmuses seems promising and demonstrates a high long-term clinical success. Tachycardia comprising a single critical isthmus can be ablated by critical isthmus ablation only. These patients present with the highest 12-month and long-term success rates.
Luik et al. (Thu,) conducted a cohort in Left atrial tachycardia following catheter ablation of atrial fibrillation (n=35). Catheter ablation of left atrial tachycardia was evaluated on Freedom from any atrial tachycardia after 12 months. Catheter ablation of left atrial tachycardia using individualized strategies achieved 82% freedom from any atrial tachycardia and 77% freedom from any arrhythmia at 12 months.