Recurrent spontaneous clinical perimitral atrial tachycardia in the context of atrial fibrillation ablation
Abstract
Background Recurrent perimitral atrial tachycardia (AT) is a challenging arrhythmia and is frequently encountered in the context of atrial fibrillation (AF) ablation.Objective The purpose of this study was to investigate the clinical characteristics and the procedural and clinical outcomes in patients with recurrent perimitral atrial tachycardia (PMAT) after AF ablation.Methods Among 520 consecutive ablation procedures for recurrent AT/AF after AF ablation, 40 procedures (patients) were performed for clinically recurrent PMAT 12.1 ± 13.6 months after the last procedure (total 2.2 ± 1.3 procedures). Previously, mitral isthmus (MI) linear ablation was performed in 26 of 40 procedures, including 13 procedures with complete block and 13 with 159.0 ± 23.0 ms of conduction delay without block. As a reference group, conduction delay was evaluated in 55 patients with incomplete MI block and absence of spontaneous PMAT during the follow-up period.Results Recurrent PMATs were terminated by MI linear ablation in 26 of 40 patients. Bidirectional block across the MI and anterior line joining the mitral annulus and left atrial roof was achieved in 33 (82.5%) and 2 (5%) patients, respectively. At mean follow-up of 26.7 ± 14.5 months, 2 patients (5%) underwent reablation for spontaneously recurrent PMAT. At 12 months after the ablation procedure for PMAT, 73.5% of the patients were free from AT/AF. Conduction delay >149 ms predicted the occurrence of spontaneous PMAT with 80.0% sensitivity and 87.3% specificity.Conclusion PMAT can recur even after successful bidirectional MI linear block. Substantial conduction delay without block across the MI from a previous procedure(s) could predispose to recurrent PMAT. Although most clinical PMATs can be successfully treated by catheter ablation, very late recurrence is possible.
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Ablation of atypical atrial flutter/macroreentrant tachycardia is more challenging and has a lower success rate and higher recurrence rate than cavotricuspid isthmus ablation.
“Atypical AFL/MRT ablation can be very challenging and has a lower success rate and a higher recurrence rate than CTI ablation.163,164,204 -206”
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 [204]
Cites
Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., DiMarco, J., et al. (2012) · Europace · doi:10.1093/europace/eus027 · Cited by 2,722 · see citing works
Nademanee, K., McKenzie, J. P., Kosar, E. M., Schwab, M., Sunsaneewitayakul, B., Vasavakul, T., Khunnawat, C., & Ngarmukos, T. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.12.054 · Cited by 2,004 · see citing works
Calkins, H., Kuck, K., Cappato, R., Brugada, J., Camm, A., Chen, S.-A., Crijns, H., Damiano, R., Davies, D., Dimarco, J., et al. (2012) · Journal of interventional cardiac electrophysiology · doi:10.1007/s10840-012-9672-7 · Cited by 1,959 · see citing works
Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., DiMarco, J., et al. (2012) · Heart Rhythm · doi:10.1016/j.hrthm.2011.12.016 · Cited by 1,456 · see citing works
Electrophysiological Breakthroughs From the Left Atrium to the Pulmonary Veins
Haı̈ssaguerre, M., Shah, D. C., Jaı̈s, P., Hocini, M., Yamane, T., Deisenhofer, I., Chauvin, M., Garrigue, S., & Clémenty, J. (2000) · Circulation · doi:10.1161/01.cir.102.20.2463 · Cited by 952 · see citing works
Haı̈ssaguerre, M., Hocini, M., Sanders, P., Sacher, F., Rotter, M., Takahashi, Y., Rostock, T., Hsu, L., Bordachar, P., Reuter, S., et al. (2005) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2005.00308.x · Cited by 755 · see citing works
Technique and Results of Linear Ablation at the Mitral Isthmus
Jaı̈s, P., Hocini, M., Hsu, L., Sanders, P., Scavée, C., Weerasooriya, R., Macle, L., Raybaud, F., Garrigue, S., Shah, D. C., et al. (2004) · Circulation · doi:10.1161/01.cir.0000146917.75041.58 · Cited by 751 · see citing works
Hocini, M., Jaı̈s, P., Sanders, P., Takahashi, Y., Rotter, M., Rostock, T., Hsu, L., Sacher, F., Reuter, S., Clémenty, J., et al. (2005) · Circulation · doi:10.1161/circulationaha.105.541052 · Cited by 494 · see citing works
P-Wave Morphology in Focal Atrial Tachycardia
Kistler, P. M., Roberts‐Thomson, K. C., Haqqani, H. M., Fynn, S. P., Singarayar, S., Vohra, J. K., Morton, J. B., SPARKS, P. B., & Kalman, J. M. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.03.058 · Cited by 382 · see citing works
Atrial Tachycardia After Circumferential Pulmonary Vein Ablation of Atrial Fibrillation
Chae, S., Oral, H., Good, E., Dey, S., Wimmer, A., Crawford, T., Wells, D., Sarrazin, J.-F., Chalfoun, N., Kuhne, M., et al. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.07.044 · Cited by 355 · see citing works
Chugh, A., Oral, H., Lemola, K., Hall, B., Cheung, P., Good, E., Tamirisa, K., Han, J., Bogun, F., Pelosi, F., et al. (2005) · Heart Rhythm · doi:10.1016/j.hrthm.2005.01.027 · Cited by 338 · see citing works
Clinical Outcomes of Catheter Substrate Ablation for High-Risk Patients With Atrial Fibrillation
Nademanee, K., Schwab, M., Kosar, E. M., Karwecki, M., Moran, M. D., Visessook, N., Michael, A. D., & Ngarmukos, T. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.10.044 · Cited by 318 · see citing works
Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation
Knecht, S., Hocini, M., Wright, M. J., Lellouche, N., O'Neill, M. D., Matsuo, S., Nault, I., Chauhan, V. S., Makati, K. J., Bevilacqua, M., et al. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn302 · Cited by 259 · see citing works
JAÏS, P., MATSUO, S., KNECHT, S., WEERASOORIYA, R., HOCINI, M., SACHER, F., WRIGHT, M., NAULT, I., LELLOUCHE, N., KLEIN, G., et al. (2009) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01373.x · Cited by 255 · see citing works
Fassini, G. M., Riva, S. I., Chiodelli, R., Trevisi, N. M., Berti, M., Carbucicchio, C., Maccabelli, G., Giraldi, F., & Bella, P. E. D. (2005) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2005.50192.x · Cited by 244 · see citing works
Differential pacing for distinguishing block from persistent conduction through an ablation line
Shah, D., Haïssaguerre, M., Takahashi, A., Jaïs, P., Hocini, M., & Clémenty, J. (2000) · Circulation · doi:10.1161/01.cir.102.13.1517 · Cited by 242 · see citing works
Takahashi, Y., O'Neill, M. D., Hocini, M., Dubois, R., Matsuo, S., Knecht, S., Mahapatra, S., Lim, K., Jaı̈s, P., Jonsson, A., et al. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.10.056 · Cited by 239 · see citing works
Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation
Mesas, C., Pappone, C., Lang, C., Gugliotta, F., Tomita, T., Vicedomini, G., Sala, S., Paglino, G., Gulletta, S., Ferro, A., et al. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.05.072 · Cited by 219 · see citing works
Becker, A. E. (2004) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2004.03651.x · Cited by 175 · see citing works
Chronic Atrial Fibrillation Is a Biatrial Arrhythmia
Rostock, T., Steven, D., Hoffmann, B. A., Servatius, H., Drewitz, I., Sydow, K., Müllerleile, K., Ventura, R., Wegscheider, K., Meinertz, T., et al. (2008) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.108.772392 · Cited by 141 · see citing works
Wittkampf, F. H. M., van Oosterhout, M. F. M., Loh, P. K. K., Derksen, R., Vonken, E.-J. P. A., Slootweg, P. J., & Ho, S. Y. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi095 · Cited by 139 · see citing works
Long-term evaluation of atrial fibrillation ablation guided by noninducibility
Jaı̈s, P., Hocini, M., Sanders, P., Hsu, L., Takahashi, Y., Rotter, M., Rostock, T., Sacher, F., Clémenty, J., & Haı̈ssaguerre, M. (2006) · Heart Rhythm · doi:10.1016/j.hrthm.2005.11.012 · Cited by 125 · see citing works
Shah, D. C., Sunthorn, H., Burri, H., Gentil-Baron, P., Pruvot, E. J., Schläpfer, J., & FROMER, M. A. (2006) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2006.00413.x · Cited by 121 · see citing works
Gerstenfeld, E. P., Dixit, S., Bala, R., Callans, D. J., Lin, D., Sauer, W. H., Garcia, F. C., Cooper, J. M., Russo, A. M., & Marchlinski, F. E. (2007) · Heart Rhythm · doi:10.1016/j.hrthm.2007.05.008 · Cited by 79 · see citing works
d’Ávila, A., Thiagalingam, A., Foley, L., FOX, M., Ruskin, J. N., & Reddy, V. Y. (2008) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01185.x · Cited by 46 · see citing works
ECG manifestations of left atrial flutter
Shah, D. C. (2008) · Current Opinion in Cardiology · doi:10.1097/hco.0b013e32831ca5a8 · Cited by 29 · see citing works
Weerasooriya, R., Jaı̈s, P., Sanders, P., Scavée, C., Hsu, L., Hocini, M., Clémenty, J., & Haı̈ssaguerre, M. (2003) · Circulation · doi:10.1161/01.cir.0000083530.08597.b5 · Cited by 19 · see citing works
Miyazaki, S., Shah, A. J., Liu, X., Jadidi, A., Nault, I., Wright, M. J., Forclaz, A., Linton, N., Xhaët, O., Rivard, L., et al. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.110.958983 · Cited by 8 · see citing works
Multiple Atrial Tachycardias After Atrial Fibrillation Ablation
Miyazaki, S., Shah, A. J., & Haı̈ssaguerre, M. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.110.960997 · Cited by 7 · see citing works
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Brugada, J., Katritsis, D. G., Arbelo, E., Arribas, F., Bax, J. J., Blomström‐Lundqvist, C., Calkins, H. G., Corrado, D., Deftereos, S. G., Diller, G., et al. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehz467 · Cited by 1,278 · see citing works
Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
Atrial flutter: more than just one of a kind
Bun, S.-S., Latcu, D. G., Marchlinski, F., & Saoudi, N. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv118 · Cited by 115 · see citing works
Chen, S., Zhou, G., Lu, X., Wei, Y. Q., Xu, J., Cai, L., Wu, X., Liu, S., & Po, S. S. (2019) · EP Europace · doi:10.1093/europace/euy327 · Cited by 28 · see citing works
Ultra-High-Definition Mapping of Atrial Arrhythmias
Bun, S., Lațcu, D. G., Delassi, T., Jamili, M. E., Amoura, A. A., & Saoudi, N. C. (2016) · Circulation Journal · doi:10.1253/circj.cj-16-0016 · Cited by 25 · see citing works
Peri-mitral atrial flutter: personalized ablation strategy based on arrhythmogenic substrate
Yu, J., Chen, K., Yang, B., Zhang, F., Ju, W., Chen, H., Yang, G., Li, M., Wang, B., Gu, K., et al. (2017) · EP Europace · doi:10.1093/europace/euw431 · Cited by 24 · see citing works
High-density versus low-density mapping in ablation of atypical atrial flutter
Balt, J. C., Klaver, M. N., Mahmoodi, B. K., van Dijk, V. F., WIJFFELS, M. C. E. F., & Boersma, L. V. A. (2021) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-021-00939-7 · Cited by 21 · see citing works
Supraventricular Arrhythmias in Patients with Adult Congenital Heart Disease
Lundqvist, C. B., Potpara, T., & Malmborg, H. (2017) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2016:29:3 · Cited by 20 · see citing works
Atypical Atrial Flutter: Electrophysiological Characterization and Effective Catheter Ablation
Johner, N., Namdar, M., & Shah, D. C. (2025) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.16543 · Cited by 16 · see citing works
The mechanisms of recurrent atrial arrhythmias after second-generation cryoballoon ablation
Miyazaki, S., Horie, T., Hachiya, H., Hasegawa, K., Kajiyama, T., Watanabe, T., Nakamura, H., Ishikawa, E., Mukai, M., Aoyama, D., et al. (2019) · American Heart Journal · doi:10.1016/j.ahj.2019.12.002 · Cited by 15 · see citing works
Ridge-related reentry despite apparent bidirectional mitral isthmus block
Jiang, C., Dong, J., Long, D., Yu, R., Tang, R., Sang, C., Ning, M., Li, S., Guo, X., Du, X., et al. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.06.018 · Cited by 13 · see citing works
Acute conduction recurrence of mitral isthmus: Incidence, clinical characteristics, and implications
Lu, X., Peng, S., Xu, J., Wang, R., Pang, L., Zhou, G., Wei, Y. Q., Cai, L., Wu, X., Guo, S., et al. (2020) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14110 · Cited by 12 · see citing works
Miyazaki, S., Hasegawa, K., Yamao, K., Ishikawa, E., Mukai, M., Aoyama, D., Nodera, M., Yamaguchi, J., Shiomi, Y., Tama, N., et al. (2020) · Heart Rhythm · doi:10.1016/j.hrthm.2020.09.016 · Cited by 11 · see citing works
Ioannidis, P., Christoforatou, E., Zografos, T. A., Charalambopoulos, P., Kouvelas, K., Christoulas, G., Syros, P. K., Tsitsinakis, G., Kappou, T., Tsoumeleas, A., et al. (2021) · Journal of Arrhythmia · doi:10.1002/joa3.12545 · Cited by 8 · see citing works
Budaraju, D., Neelapu, B. C., Pal, K., & Sivaraman, J. (2023) · Biomedizinische Technik/Biomedical Engineering · doi:10.1515/bmt-2022-0430 · Cited by 6 · see citing works
Anatomical knowledge for the ablation of left and right atrial flutter
Soto, N., Datino, T., González‐Casal, D., González‐Panizo, J., Sánchez‐Quintana, D., Macías, Y., & Cabrera, J. Á. (2022) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-022-00865-9 · Cited by 4 · see citing works
Bunin, Y. А., Miklishanskaya, S. V., Александровна, З. Е., & Васильевна, Ч. В. (2019) · Rational Pharmacotherapy in Cardiology · doi:10.20996/1819-6446-2019-15-1-115-124 · Cited by 4 · see citing works
Ouyang, F. O., & Maurer, T. (2019) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2019.10.011 · Cited by 4 · see citing works
Mukai, M., Miyazaki, S., Hasegawa, K., Ishikawa, E., Aoyama, D., Nodera, M., Kaseno, K., Miyahara, K., Matsui, A., Shiomi, Y., et al. (2020) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.14420 · Cited by 3 · see citing works
Macroreentrant Atrial Tachycardia
Issa, Z. F., Miller, J. M., & Zipes, D. P. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-52356-1.00013-x · Cited by 2 · see citing works
Nishiyama, T., Kimura, T., Fujisawa, T., Nakajima, K., Kunitomi, A., Kashimura, S., Katsumata, Y., Nishiyama, N., Aizawa, Y., Fukuda, K., et al. (2017) · Oncotarget · doi:10.18632/oncotarget.17092 · Cited by 2 · see citing works
Ebner, B., Grant, J. K., Vincent, L. T., Maning, J., Olorunfemi, O. E., Olarte, N., Colombo, R. A., Lambrakos, L. K., & Mendoza, I. J. (2021) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-021-00982-4 · Cited by 2 · see citing works
Murata, K., Miyazaki, S., Nitta, J., Inaba, O., Takahashi, A., Yamashita, S., Yamauchi, Y., Nagata, Y., Mizukami, A., Takahashi, Y., et al. (2026) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.70299 · Cited by 1 · see citing works
Perimitral atrial tachycardia passing through a completely blocked mitral isthmus line?
Miyazaki, S., Takagi, T., Matsuda, J., & Iesaka, Y. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.05.002
Katritsis, D. G., & Morady, F. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-79338-4.00021-2
Takami, M., Fujiwara, R., Suzuki, A., Kiuchi, K., Imamura, K., Tani, K., Iwai, H., Nakanishi, Y., Shoda, M., Murakami, A., et al. (2025) · Heart Rhythm O2 · doi:10.1016/j.hroo.2025.02.003
Chen, Q., Huang, Y., Dong, Y., Fan, X., Yadav, N., Jiang, L., He, Y., Chen, Z., Zhao, W., & Zhang, F. (2026) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2026.1822766
- Authors
- Miyazaki, S., Shah, A. J., Hocini, M., Haïssaguerre, M., & Jaïs, P.
- Affiliations
- Hôpital Cardiologique du Haut-Lévêque (FR)
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 12
- Issue
- 1
- Pages
- 104-110
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2087652214
- Cited by
- 27
- References
- 29
- Citations by year
- 2026: 2 · 2025: 2 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 3 · 2019: 6 · 2017: 3 · 2016: 3 · 2015: 2
- FWCI
- 1.83
- 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
- atrial fibrillation ablation, bidirectional block, conduction delay, recurrent arrhythmia, catheter ablation, re-ablation, mitral annulus
- MeSH terms
- Aged, Atrial Fibrillation, Electrocardiography, Female, Humans, Male, Middle Aged, Recurrence, Risk Factors, Sensitivity and Specificity, Tachycardia, Supraventricular, Cohort Studies, Case-Control Studies, Treatment Outcome, Catheter Ablation
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