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Peng X, Wang S, Ju W, Yang G, Gu K, Liu H, Li M, Chen H, Wang J, Chen M. Right atrial tachycardia after atrial fibrillation ablation: prevalence, clinical characteristics, electrophysiological mechanisms, and long-term outcomes. J Interv Card Electrophysiol 2023; 66:1641-1650. [PMID: 36692686 DOI: 10.1007/s10840-023-01482-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/14/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND This study aims to evaluate the prevalence, clinical characteristics, electrophysiological mechanisms, and long-term outcomes of right atrial tachycardia (AT) in patients who underwent ablation for atrial fibrillation (AF). METHODS From March 2010 to December 2020, 220 consecutive patients undergoing index AF ablation were referred for post-ablation AT recurrence. Thirty-five patients (35/220, 15.9%) with right AT recurrence (25 men; mean age 59.3 ± 10.2 years) were enrolled. These patients were divided into groups with right ATs exclusively (group 1) and right combined with left ATs (group 2). RESULTS Fifty-three ATs were mapped in all patients, with thirty-nine ATs originating from the right atrium. The detailed distribution of all right ATs was 22 in the cavo-tricuspid isthmus (CTI), 6 in the ostium of superior vein cava (SVC), 4 in the right free wall, 4 in the right anterior atrial septum, 2 in coronary sinus ostium, and 1 in crista terminalis. Group 2 had a significantly higher incidence of typical atrial flutter (AFL) than group 1 (11/12, 90.9% vs. 12/24, 50.0%, P = 0.03). During the mean follow-up of 43.6 ± 25.2 months after the index AT ablation, the recurrence rate of AT/AF was 22.9% (8/35), and it was lower in group 1 than in group 2 (8.3% vs. 54.5%, P = 0.01). CONCLUSION Right AT is relatively less common post-AF ablation. The CTI-dependent AFL and the ostium of SVC-derived focal AT constituted the major components of right ATs, suggesting the importance of ablation- and anatomy-related arrhythmogenic effects in the right atrium.
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Affiliation(s)
- Xiafeng Peng
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Shixin Wang
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Weizhu Ju
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Gang Yang
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Kai Gu
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hailei Liu
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Mingfang Li
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hongwu Chen
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| | - Jing Wang
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| | - Minglong Chen
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
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Pachón-M JC, Pachón-M EI, Santillana P TG, Lobo TJ, Pachón CTC, Pachón-M JC, Albornoz V RN, Zerpa A JC, Ortencio F, Arruda M. Ablation of "Background Tachycardia" in Long Standing Atrial Fibrillation: Improving the Outcomes by Unmasking a Residual Atrial Fibrillation Perpetuator. J Atr Fibrillation 2017; 10:1583. [PMID: 29250230 DOI: 10.4022/jafib.1583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/19/2017] [Accepted: 08/14/2017] [Indexed: 11/10/2022]
Abstract
Background Catheter ablation of long-standing persistent AF (LSAF) remains challenging. Since AF-Nest (AFN) description, we have observed that a stable, protected, fast source firing, namely "Background Tachycardia"(BT), could be hidden beneath the chaotic AF. Following pulmonary vein isolation (PVI)+AFN ablation one or more BT may arise or be induced in 30-40% of patients, which could be the culprit forAF maintenance and ablation recurrences. Methods and Results We studied 114 patients, from 322 sequential LSAF regular ablations, having spontaneous or induced residual BT after EGM-guided PVI+AFN ablation of LSAF; 55.6±11y/o, 97males (85.1%), EF=65.5±8%, LA=42.8±6.7mm. Macroreentrant tachycardias were excluded. Pre-ablationAF 12-leads ECG Digital processing(DP) and spectral analysis(SA) was performed searching for BT before AF ablation and its correlation with BT during ablation.After PVI, 38.1±9 AFN sites/patient and 135 sustained BTs (1-3, 1.2±0.5/patient) were ablated. BT cycle length(CL) was 246.3±37.3ms. In 79 patients presenting suitable DP for SA, the BT-CL was 241.6±34.3ms with intra procedure BT-CL correlation r=0.83/p<0.01. Following BT ablation, AF could not be induced. During FU of 13→60 months(22.8±12m), AF freedom for BT RF(+) vs. BT RF(-) groups were 77.9% vs. 56.4% (p=0.009), respectively. There was no significant complication. Conclusion BT ablation following PVI and AFN ablation improved long-term outcomes ofLSAF ablation. BT is likely due to sustained microreentry, protected during AF by entry block. BT can be suspected by spectral analysis of the pre-ablation ECG and is likely one important AF perpetuator by causing electrical resonance of the AFN. This ablation strategy warrants randomized, multicenter investigation.
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Affiliation(s)
- José Carlos Pachón-M
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
| | - Enrique I Pachón-M
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
| | - Tomas G Santillana P
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
| | - Tasso Julio Lobo
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
| | - Carlos Thiene C Pachón
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
| | - Juán Carlos Pachón-M
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
| | - Remy Nelson Albornoz V
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
| | - Juán Carlos Zerpa A
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
| | - Felipe Ortencio
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
| | - Mauricio Arruda
- Institutional review board statement: The study was reviewed and approved by theinstitutional review boards of Sao Paulo Cardiology Institute (IDPC) and Sao Paulo University (USP)
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Yang G, Yang B, Wei Y, Zhang F, Ju W, Chen H, Li M, Gu K, Lin Y, Wang B, Cao K, Kojodjojo P, Chen M. Catheter Ablation of Nonparoxysmal Atrial Fibrillation Using Electrophysiologically Guided Substrate Modification During Sinus Rhythm After Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol 2016; 9:e003382. [DOI: 10.1161/circep.115.003382] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gang Yang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Bing Yang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Youquan Wei
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Fengxiang Zhang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Weizhu Ju
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Hongwu Chen
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Mingfang Li
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Kai Gu
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Yazhou Lin
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Benqi Wang
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Kejiang Cao
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Pipin Kojodjojo
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
| | - Minglong Chen
- From the Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China (G.Y., B.Y., Y.W., F.Z., W.J., H.C., M.L., K.G., Y.L., B.W., K.C., M.C.); and Cardiac Department, National University Heart Centre, Singapore, Singapore (P.K.)
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Ju W, Yang B, Chen H, Zhang F, Gu K, Yu J, Li M, Yang G, Cao K, Chen M. Mapping of Focal Atrial Tachycardia With an Uninterpretable Activation Map After Extensive Atrial Ablation. Circ Arrhythm Electrophysiol 2014; 7:598-604. [PMID: 25017400 DOI: 10.1161/circep.114.001508] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Weizhu Ju
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Bing Yang
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Hongwu Chen
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Fengxiang Zhang
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Kai Gu
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Jinbo Yu
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Mingfang Li
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Gang Yang
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Kejiang Cao
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Minglong Chen
- From the Department of Cardiology, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
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