Atrial tachycardias: Cause or effect with ablation of persistent atrial fibrillation?

Journal of Cardiovascular Electrophysiology
Seigo YamashitaPierre Jaïs

Abstract

It is largely believed that atrial tachycardias (ATs) encountered during ablation of persistent atrial fibrillation (PsAF) are a byproduct of ablative lesions. We aimed to explore the alternative hypothesis that they may be a priori drivers of AF remaining masked until other AF sources are reduced or eliminated. Radiofrequency ablation of fibrillatory drivers mapped by electrocardiographic imaging (ECGI; ECVUE™, Cardioinsight Technologies, Cleveland, OH, USA) terminated PsAF in 198 (73%) out of 270 patients (61 ± 10 years, 9 ± 9 m). Two hundred and six ATs in 158 patients were subsequently mapped. Their anatomic relationship to the fibrillatory drivers prospectively identified by ECGI was then established. There were 26 (13%), 52 (25%), and 128 (62%) focal, localized, and macrore-entrant ATs, respectively. In focal/localized re-entrant ATs, 64 (82%) were terminated within an AF-driver region, in which 26 (81%) among 32 focal/localized ATs analyzed with 3-D-mapping system merged to driver map occurred from AF-driver regions in 1.0 ± 1.0 cm distance from the driver core. Importantly, there was no attempt at ablation of the associated AF-driver region in 25 of 64 (39%) of focal/localized re-entrant ATs. The sites of ATs origin gen...Continue Reading

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Citations

Apr 13, 2019·Journal of Cardiovascular Electrophysiology·Jennifer J B ViceraShih-Ann Chen
May 15, 2020·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·P IoannidisI Kanonidis
Nov 7, 2020·Journal of Cardiovascular Electrophysiology·Decebal G LațcuNadir Saoudi
Dec 1, 2018·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Antonio FronteraPierre Jaïs

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