Peri-mitral atrial flutter in patients with atrial fibrillation ablation

Matsuo, Seiichiro; Wright, Matthew; Knecht, Sébastien; Nault, Isabelle; Lellouche, Nicolas; Lim, Kang‐Teng; Arantès, Leonardo; O’Neill, Mark; Hocini, Mélèze; Jaı̈s, Pierre; Haı̈ssaguerre, Michel

doi:10.1016/j.hrthm.2009.09.067

Cited by 137 publications

(126 citation statements)

References 26 publications

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“…It has been widely demonstrated that incomplete block across the ablation lines can be responsible for AT recurrence. 510,511,512,513 Therefore, if linear ablation lesions are applied, operators should use mapping and pacing maneuvers to assess for line completeness (Class I, LOE C-LD) (Table 3). Well-designed, prospective, randomized clinical trials must be the ultimate test of linear ablation techniques.…”

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

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Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

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“…125,126 Recovery of slow conduction across ablation lines in the mid-term appears to be the arrhythmogenic mechanism in most cases. 127,128 An ECG pattern of interatrial (Bachmann) block is often associated with atypical flutter/MRT based in the LA. 129,130 This ECG pattern may be associated too with inexcitable, low-voltage areas in the LA (see Figure 10).…”

Section: Left Atrial Macro-re-entrant Tachycardiasmentioning

confidence: 99%

Atrial Flutter, Typical and Atypical: A Review

Cosío

2017

Arrhythmia &Amp; Electrophysiology Review

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Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use. Electrophysiological studies have defined multiple mechanisms of tachycardia, both re-entrant and focal, with varying ECG morphologies and rates, authenticated by the results of catheter ablation of the focal triggers or critical isthmuses of re-entry circuits. In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava–tricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. Secondary prevention, based on the treatment of associated atrial fibrillation risk factors, is emerging as a therapeutic option. In patients subjected to cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro-re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases.

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“…4 Peri-mitral AT and LA roof reentrant AT can result from either a gap-related or non-gap-related mechanism. 1,5,6,13 Gap-related mechanisms are most common, but non-gaprelated peri-mitral AT and LA roof reentrant AT also have been reported to occur as both early secondary AT 13 and late secondary AT. 1,5,6 These ATs should be ablated only when they occur as gap-related ATs.…”

Section: Relationship Between Early and Late Secondary Atmentioning

confidence: 99%

Atrial Tachycardia During Ongoing Atrial Fibrillation Ablation - EnSite Array Analysis -

Nagamoto¹,

Tsuchiya²,

Miyamoto³

et al. 2011

Circ J

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Background: Atrial tachycardia (AT) occurring during atrial fibrillation (AF) ablation is sometimes difficult to identify and eliminate. EnSite Array (EA) visualizes beat-to-beat virtual activation of AT. The aim of the present study was to characterize AT occurring during AF ablation during ongoing AF, using EA. Methods and Results:Among 90 patients with AF (paroxysmal, n=67; persistent, n=23) who underwent radiofrequency catheter ablation during ongoing AF, 33 (37%) had 46 ATs that developed during ablation, and 9 (10%) of these patients had 9 ATs that developed before ablation. AT was sustained in 39 and non-sustained in 7. Nineteen ATs resulted from a focal mechanism and 27 from macroreentry. The major AT foci were distributed in the pulmonary vein (n=8) and left atrial roof (n=3), and macroreentrant ATs mainly consisted of peri-mitral AT (n=10), common atrial flutter (n=10), and roof reentrant AT (n=3). After EA-guided ablation of AT, 41 ATs in 28 patients (85%) were eventually rendered non-inducible. During 21±8 months of follow-up, 30 of the 33 patients (91%) were free from AF/AT recurrence. Conclusions:AT occurred in 37% of the patients during ongoing AF ablation, resulting from a focal or reentrant mechanism in diverse locations. Peri-mitral AT, common atrial flutter, and AT from the pulmonary vein were frequently observed. These ATs were eliminated by EA-guided radiofrequency ablation in most cases. (Circ J 2011; 75: 1080 - 1089)

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Peri-mitral atrial flutter in patients with atrial fibrillation ablation

Cited by 137 publications

References 26 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Atrial Flutter, Typical and Atypical: A Review

Atrial Tachycardia During Ongoing Atrial Fibrillation Ablation - EnSite Array Analysis -

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