Key result
During sequential ablation for persistent AF, ~79% of direct atrial tachycardia transitions abruptly slow.
Observational (n=29)
Transitions between atrial tachycardias during persistent AF ablation occur frequently and abruptly, suggesting the simultaneous presence of multiple active tachycardia mechanisms.
Supports multiple coexisting mechanisms in persistent AF; leaves open whether targeting transitions improves ablation outcomes.
BACKGROUND: The "sequential ablation" strategy for persistent AF is aimed at progressive organization of AF until the rhythm converts to sinus rhythm or atrial tachycardia (AT). During ablation of an AT, apparently seamless transitions from one organized AT to another occur. The purpose of our study was to quantify the occurrence and the mechanism of this transition. METHODS AND RESULTS: Twenty-nine of 90 patients undergoing ablation for persistent AF had multiple AT during the procedure and constitute the study group. Thirty-nine direct transitions from one AT to another during ablation were observed classified in four types: type I (79.4%), i.e., a direct transition of a faster to a slower tachycardia without significant intervening pause; type II (7.69%)--transition after intervening ectopy or longer pause; type III (10.26%)--A slower AT accelerated; type IV (2.56%)--alteration of activation sequence but with no change on CL. CONCLUSIONS: Transition to a second AT occurs frequently in the midst of ablation of AT in persistent AF patients. This transition occurs most commonly abruptly within the range of a single cycle length of the original AT. This is best explained by a continuation of AT that was "present" simultaneously with the pretransition tachycardia, being "entrained" (for a reentrant tachycardia) or "overdriven" for an automatic focal tachycardia. The presence of multiple tachycardia mechanisms active simultaneously would be consistent with the eclectic pathophysiology of persistent AF.
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Arantès et al. (2010) conducted an observational in Persistent Atrial Fibrillation (n=29). Sequential ablation was evaluated on Occurrence and mechanism of transition from one atrial tachycardia to another. During sequential ablation for persistent atrial fibrillation, direct transitions between atrial tachycardias occurred frequently, with 79.4% being abrupt transitions to a slower tachycardia.