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Yakabe D, Ohtani K, Araki M, Inoue S, Nakamura T. Long-term outcomes after catheter ablation for idiopathic atypical atrial flutter. Heart Rhythm 2024:S1547-5271(24)02378-6. [PMID: 38615868 DOI: 10.1016/j.hrthm.2024.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Idiopathic atypical (non-cavotricuspid isthmus-dependent) atrial flutter (IAAFL) may be seen in patients without structural heart disease and without previous cardiac surgery or ablation. OBJECTIVE This study sought to determine the patient characteristics, electrophysiologic and electroanatomic properties, and clinical outcomes after ablation in patients with IAAFL. METHODS We retrospectively compared IAAFL patients with cavotricuspid isthmus-dependent AFL (C-AFL) patients undergoing catheter ablation. The primary outcome was a composite of death from cardiovascular causes, ischemic stroke, and hospitalization for worsening of heart failure. RESULTS Of 180 patients who underwent catheter ablation for AFL, 89 were included in this study (22 IAAFL and 67 C-AFL). Electrophysiologic study showed significantly longer intra-atrial conduction time and lower atrial voltage during sinus rhythm in the IAAFL group compared with the C-AFL group. The atrial scar was observed in all 22 IAAFL patients, with the most common sites being the posterior or lateral wall of the right atrium in 10 (45.5%) and the anterior wall of the left atrium in 8 (36.4%). During 3.5 ± 2.8 years of follow-up, the composite primary end point occurred significantly more frequently in the IAAFL group (hazard ratio [HR], 3.45; 95% confidence interval [CI], 1.20-9.89; P = .015). In multivariable analysis, brain natriuretic peptide levels (HR, 1.01; 95% CI, 1.00-1.01, per 1 pg/mL; P = .01) and IAAFL (HR, 4.14; 95% CI, 1.21-14.07; P = .02) were independently associated with the primary outcome. CONCLUSION IAAFL in patients had distinct electrophysiologic features suggestive of atrial cardiomyopathy. These patients are at risk for development of cardiovascular adverse events after ablation.
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Affiliation(s)
- Daisuke Yakabe
- Department of Cardiovascular Medicine, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kisho Ohtani
- Department of Cardiovascular Medicine, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
| | - Masahiro Araki
- Department of Cardiovascular Medicine, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shujiro Inoue
- Department of Cardiovascular Medicine, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Toshihiro Nakamura
- Department of Cardiovascular Medicine, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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2
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Zaidi A, Kirzner J, Liu CF, Cheung JW, Thomas G, Ip JE, Lerman BB, Markowitz SM. Localized Re-Entry Is a Frequent Mechanism of De Novo Atypical Flutter. JACC Clin Electrophysiol 2024; 10:235-248. [PMID: 38069971 DOI: 10.1016/j.jacep.2023.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Limited data exist about the origins and mechanisms of atypical atrial flutter that occurs in the absence of prior ablation or surgery. OBJECTIVES The aims of this study were to report a large cohort of patients who presented for catheter ablation of de novo atypical flutters, to identify the most common locations and mechanisms of arrhythmia, and to describe outcomes after ablation. METHODS Demographic, electrophysiological, and outcome data were collected for patients who underwent ablation of de novo atypical flutter. RESULTS The mechanisms of 85 atypical flutters were identified in 62 patients and localized to the left atrium (LA) in 58 and right atrium (RA) in 27. In the LA, mechanisms were classified as macro-re-entry in 29 (50%) and localized re-entry in 29 (50%), whereas in the RA, mechanisms were macro-re-entry in 8 (30%) and localized re-entry in 19 (70%) (proportion of localized re-entry in the LA vs. RA, P = 0.08). Nine patients had both localized and macro-re-entrant atypical flutters. In the LA, localized re-entry was commonly found in the anterior LA, followed by the pulmonary veins and septum. In the RA, localized re-entry was found at various sites, including the lateral or posterior RA, septum, and coronary sinus ostium. During 39.4 months (Q1-Q3: 18.2-65.8 months) of follow-up, atrial arrhythmias occurred in 66% of patients after a single ablation and in 50% after >1 ablation. Among patients who underwent repeat ablation, compared with the index arrhythmia, different tachycardia circuits or arrhythmias were documented in 13 of 18 cases (72%). CONCLUSIONS Atypical atrial flutters in patients without prior surgery or complex ablation are often due to localized re-entry (approximately 50% in the LA and a higher frequency in the RA). Other atrial tachycardias commonly occur during long-term follow-up following ablation, suggesting progressive atrial myopathy in these patients.
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Affiliation(s)
- Alyssa Zaidi
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Jared Kirzner
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Christopher F Liu
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA
| | - Jim W Cheung
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA
| | - George Thomas
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA
| | - James E Ip
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA
| | - Steven M Markowitz
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA.
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Seo J, Park YM, Shin YH, Jang AY, Kang WC, Chung W, Kim Y, Choi IS. Improved intra-atrial conduction delay after successful ablation for atrial fibrillation by scar homogenization in right atrium. Ann Noninvasive Electrocardiol 2023; 28:e13091. [PMID: 37786276 PMCID: PMC10646382 DOI: 10.1111/anec.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/17/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
Atrial fibrosis in the right atrium (RA) presenting as a low-voltage zone might be the mechanism of atrial fibrillation (AF) and intra-atrial conduction delay. The impact of scar homogenization in RA on intra-atrial conduction delay is unknown. We describe a patient with paroxysmal AF and significant intra-atrial conduction delay with repetitive atrial flutter, triggered from the lateral free wall in the RA between the significant low-voltage zone and slow conduction area after pulmonary vein isolation. Linear ablation along the trabeculated lateral free wall in the RA to homogenize the scar was successfully performed, and the intra-atrial conduction delay improved ultimately.
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Affiliation(s)
- Jeongduk Seo
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | - Yae Min Park
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | - Yong Hoon Shin
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | | | - Woong Chol Kang
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | - Wook‐Jin Chung
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | - Young‐Hoon Kim
- Cardiology DivisionKorea University Anam HospitalSeoulKorea
| | - In Suck Choi
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
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Characteristics and Ablation Outcomes of Atrial Tachycardia in Patients with Prior Cardiac Surgery vs. Spontaneous Scars: Where Are the Differences? J Clin Med 2022; 11:jcm11185407. [PMID: 36143054 PMCID: PMC9505833 DOI: 10.3390/jcm11185407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/11/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Atrial scars play an important role in atrial tachycardia (AT). They can not only be found in patients with prior cardiac surgery (PCS) but also in patients without PCS or significant structural heart disease, in which case the scar is called a spontaneous scar (SS). This study aims to compare the characteristics, mechanisms and ablation outcomes of AT in patients with PCS and SS. (2) Methods: We retrospectively reviewed electrophysiological and ablative characteristics of ATs in 46 patients with PCS and 18 patients with SS. (3) Results: There were averages of 1.52 and 2.33 ATs per patient in the PCS group and SS group, respectively (p < 0.01). Cavo-tricuspid isthmus dependent atrial flutter (CTI-AFL) was presented in most patients in both groups (93.50% vs. 77.80%, p = 0.17), whereas the SS group had a higher occurrence of scar-mediated reentrant AT (SMAT) and focal AT (FAT) compared with the PCS group (88.90% vs. 39.10%, p < 0.01; 22.2% vs. 2.2%, p < 0.05). There were no significant differences in acute success rate between the two groups, whereas patients with SS had lower long-term success rate (87.0% vs. 61.1%, p < 0.05) and higher occurrence of sinus node dysfunction (SND) (4.3% vs. 22.2%, p < 0.05). (4) Conclusions: CTI-AFL is common in both patients with PCS and SS, and routine CTI ablation is recommended. Compared with patients with PCS, patients with SS have more ATs, especially with higher occurrence of SMAT and FAT, and had a lower long-term success rate and higher incidence of SND.
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5
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Paisley RD, Tan MC, Razavi M, Saeed M. Iatrogenic macroreentry arising after transseptal puncture: A case series. HeartRhythm Case Rep 2022; 8:270-274. [PMID: 35497470 PMCID: PMC9039087 DOI: 10.1016/j.hrcr.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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6
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Zhang J, Li K, Zhao A, Ding Y, Su X. Ultra-high-density mapping and ablation strategy for multiple scar-related right atrial tachycardias in patients without previous cardiac surgery. J Interv Card Electrophysiol 2021; 63:669-678. [PMID: 34918210 DOI: 10.1007/s10840-021-01062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter ablation of right atrial (RA) tachycardia in patients who have extensive spontaneous RA scarring is challenging due to the complex substrate and the potential for multiple inducible atrial tachycardias (ATs). METHODS Eighteen patients with scar-related RA AT and no prior cardiac surgery were enrolled. A total of 52 different ATs (mean 3.2 ± 1.5 ATs per patient) were observed. We endeavored to complete activation maps for 45 ATs. RESULTS By analyzing activation maps, we classified ATs into six categories. The discrepant location and extension of ESAs were associated with different AT mechanisms. CONCLUSIONS Multiple scar-related RA ATs were observed in patients without previous cardiac surgery. The detailed activation patterns of these ATs could be clearly demonstrated by using an ultra-high-density mapping system.
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Affiliation(s)
- Jinlin Zhang
- Department of Cardiology, Wuhan Asian Heart Hospital, Hubei Province, 753 Jing han Avenue, Wuhan City, 430022, NO, China.
| | - Kang Li
- Department of Cardiology, The First Affiliated Hospital of Peking University, Beijing, China
| | | | - Yansheng Ding
- Department of Cardiology, The First Affiliated Hospital of Peking University, Beijing, China
| | - Xi Su
- Department of Cardiology, Wuhan Asian Heart Hospital, Hubei Province, 753 Jing han Avenue, Wuhan City, 430022, NO, China
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Al-Kaisey AM, Parameswaran R, Joseph SA, Kistler PM, Morton JB, Kalman JM. Extensive right atrial free wall low-voltage zone as the substrate for atrial fibrillation: successful ablation by scar homogenization. Europace 2021; 23:59-64. [PMID: 33141888 DOI: 10.1093/europace/euaa233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/26/2020] [Accepted: 07/17/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Prior studies have described a variety of mechanisms for atrial fibrillation (AF) originating in the right atrium (RA). In this study, we report a series of patients in whom an extensive right atrial free wall low-voltage zone (LVZ) served as the AF substrate. METHODS AND RESULTS Five patients with a clinical syndrome of paroxysmal AF and atrial tachycardia (AT) underwent electrophysiologic evaluation. Five patients (3 M; age 52 ± 7 years) had symptomatic paroxysmal AF for (28 ± 17 months) not responsive to medical therapy. At the initial EP study, AT was inducible in four patients and was spontaneous in one patient. In all patients, tachycardia instability precluded detailed AT mapping. Sinus or pace maps indicated an extensive LVZ in the lateral RA trabeculated free wall which consisted of regions of low amplitude complex signals interspersed between electrically silent areas. Radiofrequency ablation aimed at rendering the LVZ electrical inert was successful in eliminating AF in four of five patients. At a follow-up of 28 ± 15 months, one patient had an isolated recurrence of AF. However, two patients required repeat ablation for recurrent AT. CONCLUSION An extensive LVZ in the trabeculated RA free wall constitutes an unusual substrate for AF. These patients also demonstrate unstable ATs originating from the same zone. Radiofrequency ablation to render the low-voltage zone electrically inert is an effective strategy to manage AF and AT.
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Affiliation(s)
- Ahmed M Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Grattan Street, Parkville, Victoria 3050, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Grattan Street, Parkville, Victoria 3050, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Stephen A Joseph
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Grattan Street, Parkville, Victoria 3050, Australia.,Department of Cardiology, The Western Hospital, Melbourne, Australia
| | - Peter M Kistler
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Baker IDI Heart & Diabetes Institute, Melbourne, Australia.,Heart Centre, The Alfred Hospital, Melbourne, Australia
| | - Joseph B Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Grattan Street, Parkville, Victoria 3050, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Grattan Street, Parkville, Victoria 3050, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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8
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Cherian TS, Supple G, Smietana J, Santangeli P, Nazarian S, Lin D, Hyman MC, Walsh K, Marchlinski F, Arkles J. Idiopathic Atypical Atrial Flutter Is Associated With a Distinct Atriopathy. JACC Clin Electrophysiol 2021; 7:1193-1195. [PMID: 34332868 DOI: 10.1016/j.jacep.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022]
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9
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Gandhavadi M, Cox EJ. Prevalence of intra-atrial reentrant tachycardia following mitral valve surgery: Relationship to surgical approach. J Card Surg 2020; 35:1871-1876. [PMID: 32652703 DOI: 10.1111/jocs.14745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Mitral valve (MV) surgeries create electrophysiological substrates that give rise to postoperative arrhythmias. MV surgical procedures have been associated with macro- and microreentrant arrhythmogenic circuits, as well as circuits involving the atrial roof. It is not well understood why such arrhythmias develop; therefore, the aim of this study was to describe clinical and procedure characteristics associated with atrial arrhythmias in patients with prior MV surgery. METHODS This retrospective chart review evaluated patients who had prior MV surgery and ablation procedures for atrial tachycardia between 2014 and 2018 (n = 20). Patients were classified into those exhibiting typical atrial flutter or another atrial tachyarrhythmia. RESULTS Within the 20 patient cases reviewed, 30 arrhythmias were documented. Two-thirds of arrhythmias were typical atrial flutter; the percent incidence of arrhythmias originating in the right atrial (RA) roof, around the right atriotomy scar, in the left atrium, and at the crista terminalis was 20%, 3%, 7%, and 7%, respectively. Nearly every case of RA roof flutter (n = 5/6) and most arrhythmias (n = 20/30) occurred in patients who had a transseptal approach during MV surgery. Voltage maps did not show clear differences in scarring between groups. CONCLUSION Results from this study suggest that an arrhythmogenic substrate for RA roof tachycardias is generated by transseptal approaches for MV surgery. This substrate is not clearly related to a surgical scar. These data suggest that other approaches should be considered for MV surgeries. Additionally, more research is needed to determine the mechanism for this nonscar-related arrhythmia substrate.
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Affiliation(s)
- Maheer Gandhavadi
- Heart and Vascular Department, The Everett Clinic, Everett, Washington
| | - Emily J Cox
- Providence Medical Research Center, Providence Health Care, Spokane, Washington
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10
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Pathik B, Kalman JM. Perceiving the Imperceptible in Atrial Macro-Reentry: Ultrahigh Resolution Mapping to Characterize the Critical Isthmus. Circ Arrhythm Electrophysiol 2018; 10:CIRCEP.116.004850. [PMID: 28039283 DOI: 10.1161/circep.116.004850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bhupesh Pathik
- From the Department of Cardiology, Royal Melbourne Hospital & Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Australia
| | - Jonathan M Kalman
- From the Department of Cardiology, Royal Melbourne Hospital & Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Australia.
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11
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Lei S, Jia F, He Q, Gao L, Luo S, Lei H, Zhu DWX. Spontaneous scar-based reentrant atrial flutter: Electrophysiologic characteristics and ablation outcome in a retrospective analysis. Pacing Clin Electrophysiol 2018; 41:1010-1016. [PMID: 29790192 DOI: 10.1111/pace.13383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/18/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The understanding of spontaneous scar-based reentrant atrial arrhythmia is limited. We aim to characterize the electrophysiologic and mapping features of spontaneous scar-based atrial flutter (AFL) and outcomes of catheter ablation. METHODS Consecutive patients with a diagnosis of AFL who underwent catheter ablation from January 2012 to June 2015 were screened. Scars were detected in 12 patients and were included in this study. All had negative coronary angiography. These patients were divided into right AFL (seven patients) and left AFL groups (five patients) based on electrophysiologic mappings. RESULTS Compared to patients with right AFL, the size of right atrium (RA) was smaller and left atrium (LA) was larger in the left AFL group. The proportion of the scar area was 11.1 ± 11.7 % in the RA AFL group and 7.8 ± 2.8 % in the LA AFL group. The difference was significant (P = 0.001). The acute success rates of ablation were 85.7% and 100%, respectively, in patients with right and left AFL (P = 0.304). During the follow-up, expansion of the scar area was noted in three patients with recurrent right AFL. No scar expansion was noted in one patient with recurrent left AFL. In addition, three patients with right AFL required permanent pacemaker implantation for sinus node dysfunction, and no one required pacemaker in patients with left AFL. CONCLUSIONS Spontaneous scar could serve as substrate for AFL in RA or LA. Compared to left AFL, there was a higher rate of recurrence and pacemaker implantation in patients with right AFL.
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Affiliation(s)
- Sen Lei
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fengpeng Jia
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan He
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingyun Gao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suxin Luo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han Lei
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dennis W X Zhu
- Cardiac Electrophysiology Laboratories, Regions Hospital, St. Paul, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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12
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New Insights Into an Old Arrhythmia. JACC Clin Electrophysiol 2017; 3:971-986. [DOI: 10.1016/j.jacep.2017.01.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 11/19/2022]
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13
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Kawakami H, Nagai T, Inoue K, Higaki J, Ikeda S. Abnormal atrial strain with speckle-tracking echocardiography predicts the arrhythmic substrate of atypical right atrial flutter. HeartRhythm Case Rep 2017; 3:251-254. [PMID: 28736707 PMCID: PMC5509953 DOI: 10.1016/j.hrcr.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Hiroshi Kawakami
- Address reprint requests and correspondence: Dr Hiroshi Kawakami, Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.Division of CardiologyDepartment of CardiologyPulmonology, Hypertension and NephrologyEhime University Graduate School of MedicineShitsukawaToonEhime791-0295Japan
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14
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Zhou GB, Hu JQ, Guo XG, Liu X, Yang JD, Sun Q, Ma J, Ouyang FF, Zhang S. Very long-term outcome of catheter ablation of post-incisional atrial tachycardia: Role of incisional and non-incisional scar. Int J Cardiol 2015; 205:72-80. [PMID: 26720044 DOI: 10.1016/j.ijcard.2015.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/08/2015] [Accepted: 12/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The arrhythmogenicity of right atrial (RA) incisional scar after cardiac surgery could result in atrial tachycardia (AT). Radiofrequency catheter ablation is effective in the treatment of such tachycardia. However, data regarding long-term outcomes are limited. METHODS AND RESULTS A total of 105 patients with prior RA incision who underwent radiofrequency catheter ablation of AT were included. In the first procedure, electroanatomic mapping (EAM) revealed a total of 139 ATs in 105 patients, including 88 cavotricuspid isthmus dependent atrial flutters (IDAFs), 5 mitral annulus reentrant tachycardias (MARTs), 44 intra-atrial reentrant tachycardias (IARTs) and 2 focal ATs (FATs). AT was successfully eliminated in 101 (96.1%) patients. During a mean follow-up period of 90 ± 36 months, recurrent AT was observed in 23 patients and 21 underwent a second ablation. A total of 23 ATs were identified in redo procedures including 4 IDAFs, 2 MARTs, 12 IARTs and 5 FATs. The time to recurrence was significantly different among various AT types. Acute success was achieved in 20 of 23 redo procedures. Taking a total of 21 patients presenting atrial fibrillation during follow-up into account, 85 patients (81.9%) were in sinus rhythm. No complications except for a case of RA compartmentation occurred. CONCLUSION RA incisional scar played an essential role in promoting both IDAF and IART, while non-incisional scar contributed to a substantial rate of late recurrent AT in forms of both macroreentry and small reentry. Catheter ablation using EAM system resulted in a high success rate during long-term follow-up.
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Affiliation(s)
- Gong-Bu Zhou
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Qiang Hu
- Department of Cardiology, Oriental Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Gang Guo
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Liu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-du Yang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Fei-Fan Ouyang
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - Shu Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Quantification of the cryoablation zone demarcated by pre- and postprocedural electroanatomic mapping in patients with atrial fibrillation using the 28-mm second-generation cryoballoon. Heart Rhythm 2015; 12:283-90. [DOI: 10.1016/j.hrthm.2014.11.012] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Indexed: 11/20/2022]
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