Cited by 300Cardiac Arrhythmias and TreatmentsAtrial Fibrillation Management and OutcomesCardiac electrophysiology and arrhythmias

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Mechanisms of Organized Left Atrial Tachycardias Occurring After Pulmonary Vein Isolation

Gerstenfeld, Edward P., Callans, David J., Dixit, Sanjay, Russo, Andrea M., Nayak, Hemal, Lin, David, Pulliam, Ward, Siddique, Sultan, Marchlinski, Francis E.·2004·Circulation

DOI 10.1161/01.cir.0000141369.50476.d3

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Abstract

BACKGROUND: A proarrhythmic consequence of pulmonary vein (PV) isolation can be a recurrent organized left atrial (LA) tachycardia after ablation. This arrhythmia is frequently referred to as "left atrial flutter," but the mechanism and best ablation strategy have not been determined. METHODS AND RESULTS: Isolation of arrhythmogenic PVs was initially performed by segmental ostial PV ablation guided by a circular mapping catheter in 341 patients. Patients whose predominant recurrent arrhythmia was a persistent organized tachycardia returned for mapping and ablation. Recurrent organized LA tachycardias (cycle length 253+/-33 ms, range 213 to 328 ms) occurred in 10 (2.9%) of 341 patients (age 59+/-9 years, 1 woman). Mapping was consistent with a focal origin in 8 patients and with macroreentry in 1 patient and was unclear in 1 patient owing to degeneration to atrial fibrillation. Focal tachycardias originated from reconnected segments of prior isolated PVs (6 patients), the posterior LA (1 patient), or the superior septum (1 patient). Focal atrial tachycardias were ablated with point lesions that targeted the earliest activation. All reconnected PVs were also reisolated. Reentrant LA flutter occurred around the left PVs in 1 patient. After 6.7+/-2.3 months of follow-up, 9 (90%) of 10 patients were arrhythmia free (4 of whom were taking antiarrhythmic drug therapy), and one was having recurrent atrial fibrillation. CONCLUSIONS: Recurrent organized LA tachycardia after PV isolation is uncommon and typically has a focal origin from reconnected PV ostia. Reisolation of the PV and ablation of non-PV foci are sufficient to treat this proarrhythmia. Linear lesions are only required when a macroreentrant mechanism is present.

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10.1161/circ.102.21.2619 · DOI
10.1161/circ.101.12.1409 · DOI
10.1161/circ.102.20.2463 · DOI
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2003, Pacing Clin Electrophysiol, 26, 970.

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Authors: Gerstenfeld, E. P., Callans, D. J., Dixit, S., Russo, A. M., Nayak, H., Lin, D., Pulliam, W., Siddique, S., & Marchlinski, F. E.
Affiliations: Hospital of the University of Pennsylvania (US)
ORCID: Gerstenfeld, Edward P.
Callans, David J.
Dixit, Sanjay
Russo, Andrea M.
Nayak, Hemal
Lin, David
Marchlinski, Francis E.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2004-09-14
Volume: 110
Issue: 11
Pages: 1351-1357
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.0000141369.50476.d3
OpenAlex: W1997307266
Cited by: 300
References: 22
Citations by year: 2026: 5 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 9 · 2021: 10 · 2020: 10 · 2019: 11 · 2018: 9 · 2017: 14 · 2016: 10 · 2015: 19 · 2014: 16 · 2013: 13 · 2012: 23
FWCI: 13.72
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: pulmonary vein isolation, left atrial flutter, drug-induced arrhythmia, focal atrial tachycardia, macroreentry, atrial fibrillation, catheter ablation
MeSH terms: Adult, Aged, Atrial Fibrillation, Electrocardiography, Female, Follow-Up Studies, Heart Atria, Heart Conduction System, Humans, Male, Middle Aged, Postoperative Complications, Pulmonary Veins, Recurrence, Regeneration, Tachycardia, Supraventricular, Catheter Ablation, Atrial Premature Complexes, Electrophysiologic Techniques, Cardiac

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Mechanisms of Organized Left Atrial Tachycardias Occurring After Pulmonary Vein Isolation

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