Prognostic Role of Subsequent Atrial Tachycardias Occurring During Ablation of Persistent Atrial Fibrillation: A Prospective Randomized Trial
Abstract
BACKGROUND: The role of subsequent atrial tachycardias (AT) in the context of persistent atrial fibrillation (AF) remains undetermined. This study evaluated the prognostic role of subsequent ATs for arrhythmia recurrences after catheter ablation of persistent AF. METHODS AND RESULTS: A total of 110 patients with persistent AF (63±9 years; 22 women; 61 long-lasting persistent AF) underwent pulmonary vein isolation followed by electrogram-guided ablation. After AF terminated to AT, patients were separated by the randomization protocol to receive either direct cardioversion (group A) or further ablation of subsequent ATs to sinus rhythm (group B). After a mean follow-up of 20.1±13.3 months after the first procedure, significantly more group B patients were in sinus rhythm as compared with patients in group A (30 [57%] versus 18 [34%]; P=0.02). Moreover, recurrences of AF were significantly less frequent of group B than in group A patients (10 [19%] versus 26 [49%]; P=0.001). After the last procedure (follow-up, 34.0±6.4 months), significantly more group B patients were free of AF as compared with patients of group A (49 [92%] versus 39 [74%]; P=0.01). The proportion of AT recurrences did not differ between the 2 groups after the first and final procedures. The strongest predictor for an arrhythmia-free survival after a single procedure was randomization to the procedural end point of termination to sinus rhythm by elimination of subsequent ATs (P=0.004). CONCLUSIONS: Catheter ablation of subsequent ATs increases freedom from AF but not AT, suggesting a contributing role of subsequent ATs in the mechanisms of persistent AF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01896570.
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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 [198]
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- Authors
- Rostock, T., Salukhe, T. V., Hoffmann, B. A., Steven, D., Berner, I., Müllerleile, K., Theis, C., Bock, K., Servatius, H., Sultan, A., & Willems, S.
- Affiliations
- Johannes Gutenberg University Mainz (DE)
- ORCID
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2013-12
- Volume
- 6
- Issue
- 6
- Pages
- 1059-1065
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2136791056
- Cited by
- 26
- References
- 24
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 4 · 2015: 6 · 2014: 3 · 2013: 1
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Funders
- British Heart Foundation (FS/09/018/26963)
- 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
- persistent atrial fibrillation, atrial tachycardia, catheter ablation, pulmonary vein isolation, arrhythmia recurrence, sinus rhythm maintenance, prognosis, arrhythmia mechanisms
- MeSH terms
- Aged, Atrial Fibrillation, Electric Countershock, Female, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Tachycardia, Ectopic Atrial, Catheter Ablation, Kaplan-Meier Estimate
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