Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation
Abstract
Objectives The purpose of this study was to determine the prevalence and clinical significance of macroreentrant atrial tachycardia (AT) after left atrial (LA) circumferential ablation for atrial fibrillation (AF).Background Linear ablation for AF may result in macroreentrant AT.Methods Three hundred forty-nine patients (age 54 +/- 11 years) underwent LA circumferential ablation for AF (paroxysmal in 227). Ablation lines were created around the left-sided and right-sided pulmonary veins, with additional ablation lines in the posterior LA and mitral isthmus. If macroreentrant AT was observed acutely in the electrophysiology laboratory, it was not ablated. If an organized AT occurred during follow-up, the initial strategy was rate control. If AT persisted for > 3 to 4 months, catheter ablation was performed.Results Seventy-one patients (20%) had spontaneous or induced macroreentrant AT (cycle length 244 +/- 31 ms) in the electrophysiology laboratory following LA circumferential ablation. During follow-up, 85 patients (24%) experienced spontaneous AT (cycle length 238 +/- 35 ms) at a mean of 44 +/- 62 days following LA circumferential ablation. Among the 71 patients with macroreentrant AT acutely following LA circumferential ablation, 39 (55%) developed AT during follow-up. Among the 85 patients with AT during follow-up, the tachycardia remitted without a repeat ablation procedure in 28 patients (33%), most commonly within 5 months. Twenty-eight of the 349 patients (8%) underwent a repeat ablation procedure for AT. The critical isthmus was localized to the mitral isthmus in 17 of 28 patients (61%).Conclusions Macroreentrant AT is a common form of proarrhythmia after LA circumferential ablation for AF. Because it may resolve spontaneously, ablation of AT should be deferred for several months.
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Multiple ECG patterns can sometimes be recorded in atypical atrial flutter/macroreentrant tachycardia, suggesting multiple tachycardia mechanisms, especially with structural heart disease, advanced intra-atrial conduction disturbance, surgical atriotomy, or prior atrial fibrillation ablation.
“In some cases more than one ECG pattern can be recorded, suggesting multiple tachycardia mechanisms, especially in the presence of structural heart disease, advanced intra-atrial conduction disturbance, surgical atriotomy, or after catheter ablation for AF.191 -193”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [193]
Tachycardia inducibility at the end of the procedure does not predict long-term occurrence of macroreentrant tachycardia, and most tachycardias appearing in the first 6 to 8 weeks of follow-up resolve with antiarrhythmic drugs.
“Tachycardia inducibility at the end of the procedure is not predictive of the long-term occurrence of MRT, and most of tachycardias appearing in the initial 6-8 weeks of follow-up disappear under AAD.158,193”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [193]
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- Authors
- Chugh, A., Oral, H., Lemola, K., Hall, B., Cheung, P., Good, E., Tamirisa, K., Han, J., Bogun, F., Pelosi, F., & Morady, F.
- Affiliations
- Michigan Medicine (US)
- Corresponding author
- Chugh, Aman
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2005-05
- Volume
- 2
- Issue
- 5
- Pages
- 464-471
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W1995607946
- Cited by
- 338
- References
- 16
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 9 · 2023: 9 · 2022: 15 · 2021: 14 · 2020: 12 · 2019: 18 · 2018: 9 · 2017: 17 · 2016: 8 · 2015: 26 · 2014: 11 · 2013: 13 · 2012: 30
- FWCI
- 15.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- macroreentrant atrial tachycardia, atrial fibrillation, pulmonary vein isolation, drug-induced arrhythmia, mitral isthmus, repeat ablation, paroxysmal atrial fibrillation
- MeSH terms
- Atrial Fibrillation, Electrocardiography, Female, Heart Atria, Heart Conduction System, Humans, Male, Middle Aged, Pulmonary Veins, Tachycardia, Ectopic Atrial, Catheter Ablation, Electrophysiologic Techniques, Cardiac
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