Atrial Tachycardia After Circumferential Pulmonary Vein Ablation of Atrial Fibrillation
Open accessAbstract
Objectives The aim of this study was to determine the mechanism of atrial tachycardia (AT) that occurs after ablation of atrial fibrillation (AF).Background Patients who undergo catheter ablation of AF may develop AT during follow-up.Methods Seventy-eight patients underwent an ablation procedure for AT after circumferential pulmonary vein ablation (CPVA) for AF. The 3-dimensional maps from the AF and AT procedures were compared to determine whether AT arose from a prior ablation line.Results A total of 155 ATs were mapped, and the mechanism was re-entry in 137 (88%) and focal in 18 (12%). The most common left atrial (LA) ablation targets were the mitral isthmus, roof, and septum. The critical isthmus in 115 of the 120 LA re-entrant ATs (96%) traversed a prior ablation line, consistent with a gap-related mechanism. Catheter ablation was successful in 66 of the 78 patients (85%). After a mean follow-up of 13 +/- 10 months, 60 of the 78 patients (77%) were free of AT/AF without antiarrhythmic medications. Re-entrant septal AT was associated with recurrence (odds ratio 7.3; 95% confidence interval 1.5 to 36; p = 0.02), whereas PV isolation during the AT procedure was associated with a favorable outcome (odds ratio 0.17; 95% confidence interval 0.04 to 0.81; p = 0.03).Conclusions Approximately 90% of ATs after CPVA are re-entrant, and nearly all are related to gaps in prior ablation lines. These findings suggest that the prevalence of these arrhythmias may be reduced by limiting the number of linear lesions, demonstration of linear block, and pulmonary vein disconnection during the initial AF procedure.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In atrial flutter after atrial fibrillation ablation, more than one tachycardia mechanism often coexists, both macroreentrant and focal, sometimes making circuit identification difficult, particularly when entrainment maneuvers change activation.
“In post-AF ablation AFL, more than one tachycardia mechanisms often coexist, both MRT and focal, 157,203 making sometimes difficult to identify the circuits' structures, particularly when entrainment manoeuvres result in changes in activation.”
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 [157]
Cites
Circumferential Pulmonary-Vein Ablation for Chronic Atrial Fibrillation
Oral, H., Pappone, C., Chugh, A., Good, E. D., Bogun, F. M., Pelosi, F., Bates, E., Lehmann, M. H., Vicedomini, G., Augello, G., et al. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa050955 · Cited by 975 · see citing works
Self-citationCatheter Ablation for Paroxysmal Atrial Fibrillation
Oral, H., Scharf, C., Chugh, A., HALL, B. W., Cheung, P. W., Good, E. D., Veerareddy, S., Pelosi, F., & Morady, F. (2003) · Circulation · doi:10.1161/01.cir.0000095796.45180.88 · Cited by 896 · see citing works
Self-citationOuyang, F. O., Antz, M., Ernst, S., Hachiya, H., Mavrakis, H. E., Deger, F. T., Schaumann, A., Chun, K. R. J., Falk, P., Hennig, D., et al. (2004) · Circulation · doi:10.1161/01.cir.0000151289.73085.36 · Cited by 793 · 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
Saoudi, N., Cosío, F., Waldo, A., Chen, S. A., Iesaka, Y., Lesh, M., Saksena, S., Salerno, J., & Schoels, W. (2001) · European Heart Journal · doi:10.1053/euhj.2001.2658 · Cited by 464 · see citing works
Mapping and ablation of left atrial flutters
Jaïs, P., Shah, D. C., Haïssaguerre, M., Hocini, M., Peng, J. T., Takahashi, A., Garrigue, S., Le Métayer, P., & Clémenty, J. (2000) · Circulation · doi:10.1161/01.cir.101.25.2928 · Cited by 380 · 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
Self-citationMechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation
Gerstenfeld, E. P., Callans, D. J., Dixit, S., Russo, A. M., Nayak, H., Lin, D., Pulliam, W., Siddique, S., & Marchlinski, F. E. (2004) · Circulation · doi:10.1161/01.cir.0000141369.50476.d3 · Cited by 300 · see citing works
Catheter-induced linear lesions in theleft atrium in patients with atrial fibrillation
Ernst, S., Ouyang, F. O., löber, F., Antz, M., & Kück, K. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00940-9 · Cited by 249 · 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
Left Septal Atrial Flutter: Electrophysiology, Anatomy, and Results of Ablation
Marrouche, N. F., Natale, A., Wazni, O. M., Cheng, J., Yang, Y., Pollack, H., Verma, A., Ursell, P., & Scheinman, M. M. (2004) · Circulation · doi:10.1161/01.cir.0000129439.03836.96 · Cited by 110 · see citing works
Chugh, A., Oral, H., Good, E. D., Han, J. D., Tamirisa, K. P., Lemola, K., Elmouchi, D., Tschopp, D. R., Reich, S., Igic, P., et al. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.03.053 · Cited by 107 · see citing works
Self-citationHALL, B. W., Jeevanantham, V., Simon, R. A., Filippone, J. D., Vorobiof, G., & Daubert, J. P. (2007) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-006-9052-2 · Cited by 104 · see citing works
Lemola, K., Oral, H., Chugh, A., HALL, B. W., Cheung, P. W., Han, J. D., Tamirisa, K. P., Good, E. D., Bogun, F. M., Pelosi, F., et al. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.05.069 · Cited by 100 · see citing works
Self-citationAtrial Arrhythmias After Surgical Maze
Wazni, O. M., Saliba, W. I., Fahmy, T. S. E., Lakkireddy, D., Thal, S. G., Kanj, M. H., Martin, D. O., Burkhardt, J. D., Schweikert, R. A., & Natale, A. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.05.061 · Cited by 91 · see citing works
Flutter Localized to the Anterior Left Atrium After Catheter Ablation of Atrial Fibrillation
Jaı̈s, P., Sanders, P., Hsu, L., Hocini, M., Sacher, F., Takahashi, Y., Rotter, M., Rostock, T., Bordachar, P., Reuter, S., et al. (2005) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2005.00292.x · Cited by 81 · see citing works
Cummings, J. E., Schweikert, R. A., Saliba, W. I., Hao, S. C., Martin, D. O., Marrouche, N. F., Burkhardt, J. D., Kılıçaslan, F., Verma, A., Beheiry, S., et al. (2005) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2005.40585.x · Cited by 73 · see citing works
Effects of Gap Geometry on Conduction Through Discontinuous Radiofrequency Lesions
Pérez, F. J., Wood, M. A., & Schubert, C. M. (2006) · Circulation · doi:10.1161/circulationaha.105.596593 · Cited by 55 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
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
Self-citationCalkins, 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
Self-citationKatritsis, 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
Self-citationPeri-mitral atrial flutter in patients with atrial fibrillation ablation
Matsuo, S., Wright, M., Knecht, S., Nault, I., Lellouche, N., Lim, K.-T., Arantes, L., O'Neill, M. D., Hocini, M., Jaïs, P., et al. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2009.09.067 · Cited by 153 · 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
Wasmer, K., Mönnig, G., Bittner, A., Dechering, D., Zellerhoff, S., Milberg, P., Köbe, J., & Eckardt, L. (2012) · Heart Rhythm · doi:10.1016/j.hrthm.2012.06.007 · Cited by 109 · see citing works
Catheter ablation of scar-related atypical atrial flutter
Coffey, J. O., d'Avila, A., Dukkipati, S., Danik, S. B., Gangireddy, S. R., Koruth, J. S., Miller, M. A., Sager, S. J., Eggert, C. A., & Reddy, V. Y. (2013) · EP Europace · doi:10.1093/europace/eus312 · Cited by 95 · see citing works
Esato, M., Hindricks, G., Sommer, P., Arya, A., Gaspar, T., Bode, K., Bollmann, A., Wetzel, U., Hilbert, S., Kircher, S., et al. (2009) · Heart Rhythm · doi:10.1016/j.hrthm.2008.12.013 · Cited by 58 · see citing works
TAKAHASHI, Y., TAKAHASHI, A., MIYAZAKI, S., KUWAHARA, T., TAKEI, A., FUJINO, T., FUJII, A., KUSA, S., YAGISHITA, A., NOZATO, T., et al. (2009) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01410.x · Cited by 54 · see citing works
Miyazaki, S., Shah, A. J., Hocini, M., Haïssaguerre, M., & Jaïs, P. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2014.09.055 · Cited by 27 · see citing works
- Authors
- Chae, S., Oral, H., Good, E., Dey, S., Wimmer, A., Crawford, T., Wells, D., Sarrazin, J.-F., Chalfoun, N., Kuhne, M., Fortino, J., Huether, E., Lemerand, T., Pelosi, F., Bogun, F., Morady, F., & Chugh, A.
- Affiliations
- Michigan Medicine (US)
- Corresponding author
- Chugh, Aman
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2007-10
- Volume
- 50
- Issue
- 18
- Pages
- 1781-1787
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1410999705
- Cited by
- 355
- References
- 19
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 20 · 2023: 17 · 2022: 17 · 2021: 15 · 2020: 21 · 2019: 17 · 2018: 15 · 2017: 23 · 2016: 19 · 2015: 16 · 2014: 19 · 2013: 14 · 2012: 31
- FWCI
- 13.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (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 tachycardia, atrial fibrillation, circumferential pulmonary vein ablation, focal atrial tachycardia, mitral isthmus, left atrial septum, pulmonary vein isolation, catheter ablation outcomes, atrial arrhythmia recurrence
- MeSH terms
- Aged, Atrial Fibrillation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pulmonary Veins, Recurrence, Reoperation, Risk Factors, Tachycardia, Ectopic Atrial, Treatment Outcome, Catheter Ablation, Electrophysiologic Techniques, Cardiac
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
