January 1, 2020Circulation Arrhythmia and Electrophysiology
Mechanism of Recurrence of Atrial Tachycardia
Why the study?
Atrial fibrillation ablation-related atrial tachycardia is complex, and the recurrence rate and underlying mechanisms of recurrence needed elucidation.
Population
147 patients with ATs treated with the Rhythmia system
Comparison
AT circuits during the first procedure vs redo procedure
Design
Observational cohort study
Follow-up
Mean 4.2 (2.9–11.6) months
Authors
Discussion
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Implication
Ethanol infusion of the vein of Marshall may reduce epicardial AT recurrence after AF ablation; hypothesis-generating and requires randomized confirmation.
Key Points
- To determine the recurrence rate and underlying electrophysiological mechanisms of atrial tachycardia occurring after catheter ablation for atrial fibrillation.
- Analyzed 147 patients presenting with post-ablation atrial tachycardia mapped with the high-resolution Rhythmia system.
- Performed redo ablation procedures in 44 patients to compare tachycardia circuits between the index and repeat procedures over a mean follow-up of 4.2 months.
- Atrial tachycardia recurred in 46.3% (68/147) of patients, predominantly driven by perimitral flutter (57.7% recurrence, 15/26) and roof-dependent macroreentrant tachycardia (44.4% recurrence, 8/18).
- Epicardial structures were implicated in 75.0% (18/24) of recurrent perimitral flutter cases.
- Ethanol infusion in the vein of Marshall achieved 0% (0/6) recurrence compared with 53.3% (8/15) recurrence with radiofrequency ablation alone (P=0.04).
Structured PICO
P
Population
147 patients with atrial fibrillation ablation-related atrial tachycardia (AT) treated with the Rhythmia system
I
Intervention
High-resolution mapping and ablation (including radiofrequency or ethanol infusion in the vein of Marshall)
O
Outcome
Recurrence rate and mechanisms of atrial fibrillation ablation-related AT recurrence
The main mechanism of AF ablation-related AT recurrence is the recurrence of perimitral flutter and roof-dependent macroreentrant AT, often involving epicardial structures where ethanol infusion in the vein of Marshall may be beneficial.
Cite This Study
Takigawa et al. (2020) studied this question.