Proarrhythmia of circumferential left atrial lesions for management of atrial fibrillation

DAOUD, EMILE G.; WEISS, RAUL; AUGOSTINI, RALPH; HUMMEL, JOHN D.; KALBFLEISCH, STEVEN J.; VAN DEREN, JOHN M.; DAWSON, GEORGIA; BOWMAN, KATHY

doi:10.1111/j.1540-8167.2006.00312.x

Cited by 59Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmias

Proarrhythmia of circumferential left atrial lesions for management of atrial fibrillation

DAOUD, EMILE G., WEISS, RAUL, AUGOSTINI, RALPH, HUMMEL, JOHN D., KALBFLEISCH, STEVEN J., VAN DEREN, JOHN M., DAWSON, GEORGIA, BOWMAN, KATHY·2006·Journal of Cardiovascular Electrophysiology

DOI 10.1111/j.1540-8167.2006.00312.x

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Abstract

BACKGROUND: After circumferential ablation for atrial fibrillation, new onset left atrial flutter (LA Flr) may occur. This study assessed the relationship between induced and clinical episodes of LA Flr, the rate of spontaneous resolution of LA Flr, and the proarrhythmic effect of circumferential ablation. METHODS AND RESULTS: A total 112 patients underwent circumferential LA ablation for atrial fibrillation. Immediately after completion of the ablation, LA Flr was induced in 43 of 112 (38%) patients, but was not targeted for ablation. During follow-up (14 +/- 4 months), new onset LA Flr occurred in 28 of 112 (25%) patients; however, the presence of inducible LA Flr did not identify those patients with clinical LA Flr (P = 0.6). In comparison to episodes of atrial fibrillation occurring before circumferential ablation, LA Flr was associated with a faster ventricular rate (124 +/- 19 beats/min vs 91 +/- 16 beats/min, P < 0.001), and was more likely to be persistent requiring cardioversion (86% vs 32%, P = 0.01). By >or=4 months postcircumferential ablation, clinical LA Flr resolved in 18 of 28 patients (64%). A second ablation procedure for LA Flr was performed in 9 of 10 patients. Of the 17 morphologies, 16 (94%) LA Flr circuits were successfully ablated. CONCLUSIONS: (1) LA Flrs that are induced immediately after circumferential ablation for atrial fibrillation do not identify those patients who require a second ablation procedure for clinical LA Flr; (2) Since the majority of clinical LA Flrs spontaneously resolve, ablation of LA Flr should be postponed several months; and (3) new onset LA Flr after ablation for atrial fibrillation is likely a manifestation of the proarrhythmic effect of ablation lines in the LA.

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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.
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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 [158]

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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)
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Radiofrequency Ablation of Atrial Flutter Using Large‐Tip Electrode Catheters
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Authors: DAOUD, E. G., WEISS, R., AUGOSTINI, R., HUMMEL, J. D., KALBFLEISCH, S. J., VAN DEREN, J. M., DAWSON, G., & BOWMAN, K.
Affiliations: Riverside Methodist Hospital (US)
Corresponding author: DAOUD, EMILE G.
ORCID: DAOUD, EMILE G.
AUGOSTINI, RALPH
HUMMEL, JOHN D.
KALBFLEISCH, STEVEN J.
Venue: Journal of Cardiovascular Electrophysiology
Publisher: Wiley
Published: 2005-11-23
Volume: 17
Issue: 2
Pages: 157-165
ISSN: 1045-3873 (ISSN-L)
1540-8167
DOI: 10.1111/j.1540-8167.2006.00312.x
OpenAlex: W2058681464
Cited by: 59
References: 34
Citations by year: 2024: 1 · 2021: 1 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 6 · 2015: 3 · 2014: 4 · 2013: 3 · 2012: 9
FWCI: 2.97
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of Cardiovascular Electrophysiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords: left atrial flutter, atrial fibrillation, drug-induced arrhythmia, spontaneous resolution, ventricular rate, cardioversion
MeSH terms: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Coronary Vessels, Electrocardiography, Female, Heart Atria, Humans, Male, Middle Aged, Prospective Studies, Tachycardia, Catheter Ablation

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Proarrhythmia of circumferential left atrial lesions for management of atrial fibrillation

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