Electrophysiological characteristics of localized reentrant atrial tachycardia occurring after catheter ablation of long-lasting persistent atrial fibrillation
Abstract
BACKGROUND: Mapping of recurrent atrial tachycardia (AT) after extensive ablation for long-lasting persistent atrial fibrillation (AF) is complex. We sought to describe the electrophysiological characteristics of localized reentry occurring after ablation of long-lasting persistent AF. METHODS: Out of 70 patients undergoing catheter ablation of long-lasting persistent AF, 9 patients (13%, 55 +/- 8 years, 8 males) in whom localized reentry was demonstrated in a repeat ablation were studied. Localized reentry was defined as reentry in which the circuit was localized to a small area and did not have a central obstacle. The mechanism of AT was determined by electroanatomical and entrainment mapping. RESULTS: Nine localized reentries with cycle length of 243 +/- 41 ms were mapped in 9 patients. The location of AT was the left atrial appendage in 4 patients, anterior left atrium in 2, left septum in 2, and mitral isthmus in 1. In all ATs, a critical isthmus of <10 mm in width was identified in the vicinity of the prior linear lesions or ostia of isolated pulmonary veins. Ablation of the critical isthmus, which was characterized by continuous low-voltage activity (median voltage: 0.15 mV, mean duration: 117 +/- 31 ms), terminated AT and rendered it noninducible. Additionally, ablation was performed for all of inducible ATs. At 11 +/- 7 months after the procedure, 8 of 9 patients (89%) were free from any arrhythmias. CONCLUSIONS: After ablation of long-lasting persistent AF, localized reentry may arise from a site in the vicinity of the prior ablation lesions. Ablation of the critical isthmus eliminates the arrhythmia.
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Localized reentries are localized in one segment of the atrium and depend on a very slow conduction area showing long-duration fragmented signal encompassing more than half the cycle length, which is the target for ablation.
“They are localized in one segment of the atrium and depend on a very slow conduction area showing a very long duration and fragmented signal which usually encompass more than half the cycle length and are the target for ablation.119”
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 [119]
Peri-mitral or roof-dependent macroreentrant tachycardia may occur in 4% to 20% of atrial fibrillation ablation cases, with higher rates after linear or fractionated electrogram ablation techniques.
“Peri-mitral or roof-dependent MRT may occur in 4-20% of AF ablation cases, being higher with linear or fractionated electrogram ablation techniques.119,197,198”
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 [119]
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- Authors
- TAKAHASHI, Y., TAKAHASHI, A., MIYAZAKI, S., KUWAHARA, T., TAKEI, A., FUJINO, T., FUJII, A., KUSA, S., YAGISHITA, A., NOZATO, T., HIKITA, H., SATO, A., HIRAO, K., & ISOBE, M.
- Affiliations
- Tokyo Medical and Dental University (JP)
- Corresponding author
- TAKAHASHI, YOSHIHIDE
- ORCID
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2009-06
- Volume
- 20
- Issue
- 6
- Pages
- 623-629
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W1972412778
- Cited by
- 54
- References
- 17
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 3 · 2018: 1 · 2017: 7 · 2016: 1 · 2015: 2 · 2014: 2 · 2013: 3 · 2012: 11
- FWCI
- 5.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (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, catheter ablation, critical isthmus, left atrial appendage, mitral isthmus, entrainment mapping, electroanatomical mapping, repeat ablation
- MeSH terms
- Adult, Atrial Fibrillation, Chronic Disease, Female, Humans, Male, Middle Aged, Reoperation, Tachycardia, Atrioventricular Nodal Reentry, Tachycardia, Ectopic Atrial, Treatment Outcome, Catheter Ablation, Body Surface Potential Mapping
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