Key result
Left atrial linear ablation triggers localized reentrant atrial tachycardia in ~12% of persistent AF cases.
Why the study?
The proarrhythmic effect of linear ablation in the left atrium for AF has been understood as macroreentry tachycardia, but the genesis of localized reentry has been underestimated.
Does linear ablation in the left atrium for persistent AF cause localized reentrant atrial tachycardias?
Observational (n=90)
Does linear ablation in the left atrium for persistent AF cause localized reentrant atrial tachycardias?
Linear ablation in the left atrium for atrial fibrillation can cause localized reentrant atrial tachycardias at prior lesion sites, which can be successfully mapped and eliminated with further catheter ablation.
Consider localized reentry in post-linear ablation tachycardias; extends mechanism understanding yet leaves open targeted strategies.
BACKGROUND: There is a consistent understanding that the proarrhythmic effect of linear ablation in the left atrium body for atrial fibrillation (AF) always manifests as the macroreentry tachycardia. However, its genesis of localized reentry has been underestimated. METHODS: Among 90 persistent AF patients who had accepted linear ablation in the left atrium body, a total of 11 patients (12%) presented with a localized reentry (six men, mean age 59 ± 11 years) associated with previous ablation lines. Among the 11 patients, four were encountered during the index procedure for AF ablation and the remaining seven during the redo procedure for atrial tachycardias (ATs). RESULTS: The ATs were all located at previously ablated lesion sites and manifested a centrifugal mode in both the activation mapping and pattern of the postpacing interval response. The mean tachycardia cycle length (TCL) of the localized reentrant ATs was 306 ± 73 ms. The target sites demonstrated low amplitude (0.17 ± 0.09 mV) continuous complex electrograms or long double potentials, covering 142 ± 57 ms (46 ± 12 % of the TCL). The localized reentrant tachycardias were all successfully eliminated by catheter ablation. CONCLUSIONS: A novel type of the proarrhythmic effects of linear ablation in the left atrium for AF may manifest as localized reentrant ATs, as evidenced by the association of the site of origin with the prior lesions.
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Ju et al. (2011) conducted an observational in Persistent atrial fibrillation (n=90). Linear ablation in the left atrium body was evaluated on Localized reentry. Linear ablation in the left atrium for persistent atrial fibrillation resulted in localized reentrant atrial tachycardias in 12% of patients, all of which were successfully eliminated by ablation.
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