Electrophysiological Characteristics of Localized Reentrant Atrial Tachycardia Occurring After Catheter Ablation of Long-Lasting Persistent Atrial Fibrillation |
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Authors: | YOSHIHIDE TAKAHASHI M.D. ATSUSHI TAKAHASHI M.D. SHINSUKE MIYAZAKI M.D. TAISHI KUWAHARA M.D. ASUMI TAKEI M.D. TADASHI FUJINO M.D. AKIRA FUJII M.D. SHIGEKI KUSA M.D. ATSUHIKO YAGISHITA M.D. TOSHIHIRO NOZATO M.D. HIROYUKI HIKITA M.D. AKIRA SATO M.D. KENZO HIRAO M.D. MITSUAKI ISOBE M.D. |
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Affiliation: | From the Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Japan;and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan |
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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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Keywords: | ablation atrial fibrillation mapping atrial tachycardia |
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