Narrow, Slow‐Conducting Isthmus Dependent Left Atrial Reentry Developing After Ablation for Atrial Fibrillation: ECG Characterization and Elimination by Focal RF Ablation

Shah, Dipen; Sunthorn, Henri; Burri, Haran; Gentil-Baron, Pascale; Pruvot, Étienne; Schlaepfer, J.; Fromer, Martin

doi:10.1111/j.1540-8167.2006.00413.x

Cited by 111 publications

(106 citation statements)

References 17 publications

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“…This is in keeping with other studies that identified isthmuses supporting macroreentrant circuits as low as 0.05 to 0.1 mV. 14,15 Breakout sources had a median voltage of 0.35 mV with a range from 0.14 to 0.48 mV. This overlap between nonconductive and active tissue critical to the The detailed activation and voltage maps that were created also raises the possibility of additional substrate-based treatment of potential circuits that have been identified.…”

Section: Discussionsupporting

confidence: 84%

A Prospective Study of Ripple Mapping in Atrial Tachycardias

Luther

Linton

Koa‐Wing

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Post ablation atrial tachycardias are characterized by low-voltage signals that challenge current mapping methods. Ripple mapping (RM) displays every electrogram deflection as a bar moving from the cardiac surface, resulting in the impression of propagating wavefronts when a series of bars move consecutively. RM displays fractionated signals in their entirety thereby helping to identify propagating activation in low-voltage areas from nonconducting tissue. We prospectively used RM to study tachycardia activation in the previously ablated left atrium. Methods and Results-Patients referred for atrial tachycardia ablation underwent dense electroanatomic point collection using CARTO3v4. RM was played over a bipolar voltage map and used to determine the voltage "activation threshold" that differentiated functional low voltage from nonconducting areas for each map. Ablation was guided by RM, but operators could perform entrainment or review the isochronal activation map for diagnostic uncertainty. Twenty patients were studied. Median RM determined activation threshold was 0.3 mV (0.19-0.33), with nonconducting tissue covering 33±9% of the mapped surface. All tachycardias crossed an isthmus (median, 0.52 mV, 13 mm) bordered by nonconducting tissue (70%) or had a breakout source (median, 0.35 mV) moving away from nonconducting tissue (30%). In reentrant circuits (14/20) the path length was measured (87-202 mm), with 9 of 14 also supporting a bystander circuit (path lengths, 147-234 mm). In breakout tachycardias, splitting of wavefronts resulted in 2 to 4 incomplete circuits. RMguided ablation interrupted the tachycardia in 19 of 20 cases with the first ablation set. Conclusions-RM helps to define activation through low-voltage regions and aids ablation of atrial tachycardias.(Circ Arrhythm Electrophysiol. 2016;9:e003582.

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Section: Discussionsupporting

confidence: 84%

A Prospective Study of Ripple Mapping in Atrial Tachycardias

Luther

Linton

Koa‐Wing

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…11,12 However, it does not indicate a focal mechanism, for example, automaticity or triggered activity.…”

Section: Differentiation Between Reentry and Focal Atmentioning

confidence: 99%

Characterization, Mapping, and Catheter Ablation of Recurrent Atrial Tachycardias After Stepwise Ablation of Long-Lasting Persistent Atrial Fibrillation

Rostock

Drewitz

Steven

et al. 2010

Circ: Arrhythmia and Electrophysiology

132

111

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Background-Atrial tachycardias (AT) often occur after ablation of long-lasting persistent AF (CAF) and are difficult to treat conservatively. This study evaluated mechanisms and success rates of conventional mapping and catheter ablation of recurrent ATs occurring late after stepwise ablation of CAF. Methods and Results-A total of 320 patients underwent de novo ablation of CAF using a stepwise ablation approach in 2006 to 2007 at our institution. This study comprised patients who presented with recurrent ATs at their first redo procedure after initial de novo CAF ablation. All procedures were guided by conventional mapping techniques exclusively. Sixty-one patients (63Ϯ10 years, 14 women) presented with their clinical AT at their redo procedure 7.7Ϯ4.4 months after initial de novo CAF ablation. A total of 133 ATs (2.2Ϯ0.9 per patient) were mapped. Forty-four (72%) were due to reentry; 17 (28%) were focal ATs. Reentry ATs were mainly characterized as roof and perimitral flutter (43% and 34%, respectively). Focal ATs mainly originated from the great thoracic veins (pulmonary veins: 41%, coronary sinus: 23%). Forty-five (74%) patients had conduction recovery of at least 1 pulmonary vein (mean, 1.2Ϯ0.8).Overall, 124 (93%) ATs could be ablated successfully. The mean procedure duration was 181Ϯ59 minutes, with a mean fluoroscopy time of 45Ϯ21 minutes. After a mean follow-up of 21Ϯ4 months, 50 (82%) patients were free of any arrhythmia recurrences after a single redo procedure. Conclusions-Although late recurrent ATs may have complex mechanisms, catheter ablation guided exclusively by conventional techniques is highly effective with excellent acute and long-term success rates. (Circ Arrhythm Electrophysiol. 2010;3:160-169.)

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“…Nevertheless, performing linear lesions in dilated LA can be challenging due to the fact thatthey have to be longer than in not-dilated LA. The vast majority of arrhythmias that occur after CAAF are re-entrant (83%) [1][2][3][4][5][6][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] and use gaps in prior ablation lines. Elimination of the dominant arrhythmia may uncover, suppressed so far, ectopic foci.…”

Section: Wwwcardiologyjournalorgmentioning

confidence: 99%