Characterization of Reentrant Circuits in Left Atrial Macroreentrant Tachycardia: Critical Isthmus Block Can Prevent Atrial Tachycardia Recurrence
Abstract
BACKGROUND: Left atrial macroreentrant tachycardia (LAMRT) has not been characterized in detail. METHODS AND RESULTS: Twenty-eight patients with LAMRT, including 4 patients with ablated typical atrial flutter (AFL), underwent electroanatomic mapping of the left atrium (LA) between February 1999 and October 2001. LA maps were performed during LAMRT in 26 patients and during sinus rhythm in 2 patients. Electrically silent areas or continuous lines of double potentials were identified as acquired anatomic barriers in all patients. In 23 of 26 patients with LAMRT mapping, 42 reentry circuits with a protected isthmus were identified. The isthmus was 11.8+/-5.9 mm wide, with the maximal amplitude of 0.07 to 3.61 mV. Radiofrequency pulses terminated all LAMRTs in 23 patients and resulted in conduction block across the isthmus in 20 patients. In 2 patients with sinus mapping, all identified isthmuses were ablated. Additionally, AFL was induced and ablated in 6 patients. Atrial tachycardia recurred in 4 patients: 3 patients without validated block across the isthmus presented with recurrence of the same LAMRT, and 1 patient without ablated cavotricuspid isthmus presented with AFL. All tachycardias were abolished during a second procedure. Of 25 patients with identified isthmuses, 20 patients were without atrial arrhythmia and 5 had only atrial fibrillation during a median follow-up of 14 months. CONCLUSION: The reentry circuit with a protected isthmus can be identified in 89% patients with LAMRT by electroanatomic mapping. The isthmuses were amenable to radiofrequency applications in most patients. No atrial tachycardia recurred in any patients with isthmus block.
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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 [191]
Atypical atrial flutter/macroreentrant tachycardia of the left atrium is generally supported by abnormal, non-excitable areas of myocardium, sometimes from surgical or ablation scars and sometimes of unknown origin.
“Atypical AFL/MRT of the LA is generally supported by abnormal, non-excitable areas of myocardium, sometimes due to surgical or ablation scars and others of unknown origin.”
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 [191]
These non-excitable areas may form mixed obstacles by attaching to anatomical obstacles such as the mitral valve or pulmonary veins.
“These non-excitable areas may form mixed obstacles by attaching to anatomical obstacles, such as the mitral valve or the pulmonary veins.118,159,162,191,192”
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 [191]
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- Authors
- Ouyang, F., Ernst, S., Vogtmann, T., Goya, M., Volkmer, M., Schaumann, A., Bänsch, D., Antz, M., & Kuck, K.-H.
- Affiliations
- Asklepios Klinik St. Georg (DE)
- From the II Med Abteilung, Allgemeines Krankenhaus St Georg, Hamburg, Germany.
- Venue
- Circulation
- Published
- 2002-04-23
- Volume
- 105
- Issue
- 16
- Pages
- 1934-1942
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2004367293
- Cited by
- 212
- References
- 14
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 8 · 2023: 2 · 2022: 7 · 2021: 12 · 2020: 5 · 2019: 13 · 2018: 4 · 2017: 16 · 2016: 7 · 2015: 6 · 2014: 6 · 2013: 7 · 2012: 17
- FWCI
- 7.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (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
- reentrant circuit, electroanatomical mapping, atrial flutter, radiofrequency catheter ablation, conduction block, atrial tachycardia recurrence, atrial fibrillation
- MeSH terms
- Adolescent, Adult, Aged, Arrhythmias, Cardiac, Atrial Flutter, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mitral Valve, Radiography, Tachycardia, Ectopic Atrial, Catheter Ablation, Body Surface Potential Mapping, Secondary Prevention
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