Key result
Ablation of the critical isthmus in localized reentrant atrial tachycardia after ablation of long-lasting persistent atrial fibrillation resulted in 89% (8 of 9) of patients being free from arrhythmias at 11 months.
Why the study?
Does ablation of the critical isthmus eliminate localized reentrant atrial tachycardia in patients with prior ablation for long-lasting persistent atrial fibrillation?
Observational (n=9)
Does ablation of the critical isthmus eliminate localized reentrant atrial tachycardia in patients with prior ablation for long-lasting persistent atrial fibrillation?
In patients with recurrent atrial tachycardia after ablation for long-lasting persistent AF, localized reentry often occurs near prior ablation lesions and can be effectively eliminated by targeted ablation of the critical isthmus.
Answers are grounded in this paper and cite their sources.
May support targeted isthmus ablation for post-persistent AF reentrant tachycardia; hypothesis-generating in this small case series.
BACKGROUND: Mapping of recurrent atrial tachycardia (AT) after extensive ablation for long-lasting persistent atrial fibrillation (AF) is complex. We sought to describe the electrophysiological characteristics of localized reentry occurring after ablation of long-lasting persistent AF. METHODS: Out of 70 patients undergoing catheter ablation of long-lasting persistent AF, 9 patients (13%, 55 +/- 8 years, 8 males) in whom localized reentry was demonstrated in a repeat ablation were studied. Localized reentry was defined as reentry in which the circuit was localized to a small area and did not have a central obstacle. The mechanism of AT was determined by electroanatomical and entrainment mapping. RESULTS: Nine localized reentries with cycle length of 243 +/- 41 ms were mapped in 9 patients. The location of AT was the left atrial appendage in 4 patients, anterior left atrium in 2, left septum in 2, and mitral isthmus in 1. In all ATs, a critical isthmus of <10 mm in width was identified in the vicinity of the prior linear lesions or ostia of isolated pulmonary veins. Ablation of the critical isthmus, which was characterized by continuous low-voltage activity (median voltage: 0.15 mV, mean duration: 117 +/- 31 ms), terminated AT and rendered it noninducible. Additionally, ablation was performed for all of inducible ATs. At 11 +/- 7 months after the procedure, 8 of 9 patients (89%) were free from any arrhythmias. CONCLUSIONS: After ablation of long-lasting persistent AF, localized reentry may arise from a site in the vicinity of the prior ablation lesions. Ablation of the critical isthmus eliminates the arrhythmia.
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Takahashi et al. (2009) conducted an observational in Localized reentrant atrial tachycardia after catheter ablation of long-lasting persistent atrial fibrillation (n=9). Catheter ablation of the critical isthmus was evaluated on Freedom from any arrhythmias. Ablation of the critical isthmus in localized reentrant atrial tachycardia after ablation of long-lasting persistent atrial fibrillation resulted in 89% (8 of 9) of patients being free from arrhythmias at 11 months.
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