Induced atrial tachycardia after circumferential pulmonary vein isolation of paroxysmal atrial fibrillation

Electrophysiological characteristics and impact of catheter ablation on the follow-up results

Shih Lin Chang, Yenn Jiang Lin, Ching Tai Tai, Li Wei Lo, Ta Chuan Tuan, Ameya R. Udyavar, Yu Feng Hu, Shuo Ju Chiang, Wanwarang Wongcharoen, Hsuan Ming Tsao, Kwo Chang Ueng, Satoshi Higa, Pi Chang Lee, Shih Ann Chen

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Induced AT after AF ablation. Introduction: Atrial tachycardia (AT), including focal and reentrant AT, can occur after circumferential pulmonary vein isolation (CPVI). The aim of this study was to investigate the electrophysiological characteristics of induced AT and its clinical outcome. Methods and Results: In our series of 160 patients with paroxysmal atrial fibrillation (AF), 45 ATs were induced by high-current burst pacing after CPVI in 26 patients. All induced ATs were mapped using a three-dimensional (3D) mapping system. Noninducibility was the endpoint of the ablation of the AT. Gap-related AT was considered if the AT was related to the CPVI lesions. A 16-slice multidetector computed tomography scan was performed in all patients to correlate the anatomical structure with electroanatomical mapping. Thirty-five (78%) reentrant ATs and 10 (22%) focal ATs were identified. Of those, 34 were gap-related ATs (24 reentrant and 10 focal ATs). Reentrant AT had more gaps in the left atrial appendage ridge than did focal AT (39.6% vs 0%, P = 0.02). Focal AT had a higher incidence of gap in the PV carina compared with reentrant AT (80% vs 10%, P <0.001). Reentrant ATs were mostly terminated during the ablation creating the mitral and roof lines with crossing of the gaps. During a mean follow-up of 21 ± 8 months, only one patient (0.6%) with induced mitral reentry had a recurrent AT. Conclusion: The location of the AT gap may be related with the complex anatomy of the LA. The induced ATs after CPVI can be eliminated by catheter ablation.

Original languageEnglish
Pages (from-to)388-394
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number4
DOIs
Publication statusPublished - Apr 2009
Externally publishedYes

Fingerprint

Catheter Ablation
Pulmonary Veins
Tachycardia
Atrial Fibrillation
Dihydrotachysterol
Atrial Appendage
Multidetector Computed Tomography
Anatomy

Keywords

  • Atrial fibrillation
  • Atrial tachycardia
  • Catheter ablation
  • Inducibility
  • Mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Induced atrial tachycardia after circumferential pulmonary vein isolation of paroxysmal atrial fibrillation : Electrophysiological characteristics and impact of catheter ablation on the follow-up results. / Chang, Shih Lin; Lin, Yenn Jiang; Tai, Ching Tai; Lo, Li Wei; Tuan, Ta Chuan; Udyavar, Ameya R.; Hu, Yu Feng; Chiang, Shuo Ju; Wongcharoen, Wanwarang; Tsao, Hsuan Ming; Ueng, Kwo Chang; Higa, Satoshi; Lee, Pi Chang; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 20, No. 4, 04.2009, p. 388-394.

Research output: Contribution to journalArticle

Chang, Shih Lin ; Lin, Yenn Jiang ; Tai, Ching Tai ; Lo, Li Wei ; Tuan, Ta Chuan ; Udyavar, Ameya R. ; Hu, Yu Feng ; Chiang, Shuo Ju ; Wongcharoen, Wanwarang ; Tsao, Hsuan Ming ; Ueng, Kwo Chang ; Higa, Satoshi ; Lee, Pi Chang ; Chen, Shih Ann. / Induced atrial tachycardia after circumferential pulmonary vein isolation of paroxysmal atrial fibrillation : Electrophysiological characteristics and impact of catheter ablation on the follow-up results. In: Journal of Cardiovascular Electrophysiology. 2009 ; Vol. 20, No. 4. pp. 388-394.
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abstract = "Induced AT after AF ablation. Introduction: Atrial tachycardia (AT), including focal and reentrant AT, can occur after circumferential pulmonary vein isolation (CPVI). The aim of this study was to investigate the electrophysiological characteristics of induced AT and its clinical outcome. Methods and Results: In our series of 160 patients with paroxysmal atrial fibrillation (AF), 45 ATs were induced by high-current burst pacing after CPVI in 26 patients. All induced ATs were mapped using a three-dimensional (3D) mapping system. Noninducibility was the endpoint of the ablation of the AT. Gap-related AT was considered if the AT was related to the CPVI lesions. A 16-slice multidetector computed tomography scan was performed in all patients to correlate the anatomical structure with electroanatomical mapping. Thirty-five (78{\%}) reentrant ATs and 10 (22{\%}) focal ATs were identified. Of those, 34 were gap-related ATs (24 reentrant and 10 focal ATs). Reentrant AT had more gaps in the left atrial appendage ridge than did focal AT (39.6{\%} vs 0{\%}, P = 0.02). Focal AT had a higher incidence of gap in the PV carina compared with reentrant AT (80{\%} vs 10{\%}, P <0.001). Reentrant ATs were mostly terminated during the ablation creating the mitral and roof lines with crossing of the gaps. During a mean follow-up of 21 ± 8 months, only one patient (0.6{\%}) with induced mitral reentry had a recurrent AT. Conclusion: The location of the AT gap may be related with the complex anatomy of the LA. The induced ATs after CPVI can be eliminated by catheter ablation.",
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AU - Lin, Yenn Jiang

AU - Tai, Ching Tai

AU - Lo, Li Wei

AU - Tuan, Ta Chuan

AU - Udyavar, Ameya R.

AU - Hu, Yu Feng

AU - Chiang, Shuo Ju

AU - Wongcharoen, Wanwarang

AU - Tsao, Hsuan Ming

AU - Ueng, Kwo Chang

AU - Higa, Satoshi

AU - Lee, Pi Chang

AU - Chen, Shih Ann

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N2 - Induced AT after AF ablation. Introduction: Atrial tachycardia (AT), including focal and reentrant AT, can occur after circumferential pulmonary vein isolation (CPVI). The aim of this study was to investigate the electrophysiological characteristics of induced AT and its clinical outcome. Methods and Results: In our series of 160 patients with paroxysmal atrial fibrillation (AF), 45 ATs were induced by high-current burst pacing after CPVI in 26 patients. All induced ATs were mapped using a three-dimensional (3D) mapping system. Noninducibility was the endpoint of the ablation of the AT. Gap-related AT was considered if the AT was related to the CPVI lesions. A 16-slice multidetector computed tomography scan was performed in all patients to correlate the anatomical structure with electroanatomical mapping. Thirty-five (78%) reentrant ATs and 10 (22%) focal ATs were identified. Of those, 34 were gap-related ATs (24 reentrant and 10 focal ATs). Reentrant AT had more gaps in the left atrial appendage ridge than did focal AT (39.6% vs 0%, P = 0.02). Focal AT had a higher incidence of gap in the PV carina compared with reentrant AT (80% vs 10%, P <0.001). Reentrant ATs were mostly terminated during the ablation creating the mitral and roof lines with crossing of the gaps. During a mean follow-up of 21 ± 8 months, only one patient (0.6%) with induced mitral reentry had a recurrent AT. Conclusion: The location of the AT gap may be related with the complex anatomy of the LA. The induced ATs after CPVI can be eliminated by catheter ablation.

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KW - Atrial tachycardia

KW - Catheter ablation

KW - Inducibility

KW - Mapping

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