Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: Electrophysiological features and ablation outcomes

Garg, Lohit; Pothineni, Naga Venkata K.; Arroyo, Alonso; Rodríguez, Diego; García, Fermin C.; Hyman, Matthew C.; Kumareswaran, Ramanan; Arkles, Jeffrey; Schaller, Robert D.; Supple, Gregory E.; Frankel, David S.; Riley, Michael P.; Nazarian, Saman; Lin, David; Dixit, Sanjay; Callans, David J.; Zado, Erica S.; Marchlinski, Francis E.; Sáenz, Luis

doi:10.1016/j.hrthm.2021.04.036

Cited by 6 publications

(4 citation statements)

References 17 publications

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“…The localized intra‐septal BiAT is characterized by a diffused breakthrough with diffused centrifugal bi‐atrial activation. Entrainment demonstrates a good post‐pacing interval in the earliest activation, and sometimes the opposite side of earliest activation in the septum, but fails to demonstrate a planar macro‐reentrant circuit by overdrive pacing at multiple sites around the rim of FO 39 …”

Section: Special Types Of Bi‐atrial Circuitsmentioning

confidence: 99%

Epicardial connections and bi‐atrial tachycardias: From anatomy to clinical practice

Lai

Sang

et al. 2023

Pacing Clinical Electrophis

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Bi‐atrial tachycardia (BiAT) is not rare after extensive atrial ablation or cardiac surgery. The complexity of bi‐atrial reentrant circuits poses a great challenge for clinical practice. With recent advances in mapping technologies, we are now able to characterize atrial activation in detail. However, given the involvement of both atria and multiple epicardial conductions, endocardial mapping for BiATs is not easy to understand. Knowledge of the atrial myocardial architecture is the foundation for the clinical management of BiATs; as it is required to understand the possible mechanism of the tachycardia and identify the optimal target of ablation. In this review we summarize current knowledge about the anatomy of interatrial connections as well as other epicardial fibers and discuss the interpretation of electrophysiological findings and ablation strategies for BiATs.

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Section: Special Types Of Bi‐atrial Circuitsmentioning

confidence: 99%

Epicardial connections and bi‐atrial tachycardias: From anatomy to clinical practice

Lai

Sang

et al. 2023

Pacing Clinical Electrophis

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“…An increase in the thickness of the interatrial septum, often caused by fatty infiltration or fibrosis, is thought to be related to increased propensity for atrial arrhythmias (3,4). Regardless, perinodal ATs remain a relatively less common focus accounting for 7%-13% of AT cases across different cases series (5)(6)(7)(8).…”

Section: Relevant Anatomy and Arrhythmogenic Role Of The Retroaortic ...mentioning

confidence: 99%

Case report: A case of perinodal atrial tachycardia and review of the relevant clinical anatomy surrounding the retroaortic node

Raina

Tan

Fatunde

et al. 2023

Front. Cardiovasc. Med.

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A 70-year-old female presented with incessant supraventricular tachycardia that was refractory to metoprolol and sotalol. ECG revealed a narrow complex tachycardia with a rate of 163 beats per minute with a short RP relationship. She had salvos of atrial tachycardia which led to a severe reduction in ejection fraction as noted on echocardiography and hemodynamic instability. An electrophysiological study was performed, and findings suggested this to be an atrial tachycardia with earliest activation in the perinodal area. Radiofrequency ablation was carried out along the septum and associated structures to surround this region including the right atrium, non-coronary sinus of Valsalva, and the left atrium (anterior wall outside of the right superior pulmonary vein) to isolate this area and surround the focus with ablation lesions. The patient has done well post-procedure and continues to do well without any recurrence on low-dose flecainide at 8 months.

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“…Lohit Garg et al. reported a group of septal AT with different characteristics 25 . Biatrial HDMs demonstrated a diffuse right/left atrial septal breakout with centrifugal biatrial activation.…”

Section: At After Mitral Valve (Mv) Cardiac Surgerymentioning

confidence: 99%

High density mapping of atrial tachycardia in patients post cardiac surgery

Zhang

2023

Pacing Clinical Electrophis

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Mapping and ablation of atrial tachycardia (AT) in patients who have had prior cardiac surgery can be a challenge for clinical electrophysiologists. High density mapping (HDM) technology has been widely used in these patients because it provides a better characterization of the substrate and the mechanisms with an unprecedented high resolution. In this review, we summarize how the latest HDM technologies can reveal the mechanism of AT in different types of patients post‐cardiac surgery and guide a specifically tailored ablation strategy.

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Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: Electrophysiological features and ablation outcomes

Cited by 6 publications

References 17 publications

Epicardial connections and bi‐atrial tachycardias: From anatomy to clinical practice

Epicardial connections and bi‐atrial tachycardias: From anatomy to clinical practice

Case report: A case of perinodal atrial tachycardia and review of the relevant clinical anatomy surrounding the retroaortic node

High density mapping of atrial tachycardia in patients post cardiac surgery

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