Characterization, mapping, and catheter ablation of recurrent atrial tachycardias after stepwise ablation of long-lasting persistent atrial fibrillation
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Characterization, mapping, and catheter ablation of recurrent atrial tachycardias after stepwise ablation of long-lasting persistent atrial fibrillation. / Rostock, Thomas; Drewitz, Imke; Steven, Daniel; Hoffmann, Boris A; Salukhe, Tushar V; Bock, Karsten; Servatius, Helge; Aydin, Muhammet Ali; Meinertz, Thomas; Willems, Stephan.
In: CIRC-ARRHYTHMIA ELEC, Vol. 3, No. 2, 04.2010, p. 160-169.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Characterization, mapping, and catheter ablation of recurrent atrial tachycardias after stepwise ablation of long-lasting persistent atrial fibrillation
AU - Rostock, Thomas
AU - Drewitz, Imke
AU - Steven, Daniel
AU - Hoffmann, Boris A
AU - Salukhe, Tushar V
AU - Bock, Karsten
AU - Servatius, Helge
AU - Aydin, Muhammet Ali
AU - Meinertz, Thomas
AU - Willems, Stephan
PY - 2010/4
Y1 - 2010/4
N2 - 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 (63+/-10 years, 14 women) presented with their clinical AT at their redo procedure 7.7+/-4.4 months after initial de novo CAF ablation. A total of 133 ATs (2.2+/-0.9 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, 1.2+/-0.8). Overall, 124 (93%) ATs could be ablated successfully. The mean procedure duration was 181+/-59 minutes, with a mean fluoroscopy time of 45+/-21 minutes. After a mean follow-up of 21+/-4 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.
AB - 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 (63+/-10 years, 14 women) presented with their clinical AT at their redo procedure 7.7+/-4.4 months after initial de novo CAF ablation. A total of 133 ATs (2.2+/-0.9 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, 1.2+/-0.8). Overall, 124 (93%) ATs could be ablated successfully. The mean procedure duration was 181+/-59 minutes, with a mean fluoroscopy time of 45+/-21 minutes. After a mean follow-up of 21+/-4 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.
KW - Aged
KW - Atrial Fibrillation/epidemiology
KW - Catheter Ablation/statistics & numerical data
KW - Electrocardiography/statistics & numerical data
KW - Electrophysiologic Techniques, Cardiac/statistics & numerical data
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications/epidemiology
KW - Recurrence
KW - Tachycardia, Ectopic Atrial/epidemiology
KW - Treatment Outcome
U2 - 10.1161/CIRCEP.109.899021
DO - 10.1161/CIRCEP.109.899021
M3 - SCORING: Journal article
C2 - 20133933
VL - 3
SP - 160
EP - 169
JO - CIRC-ARRHYTHMIA ELEC
JF - CIRC-ARRHYTHMIA ELEC
SN - 1941-3149
IS - 2
ER -