Treatment strategy and endpoint of catheter ablation for bi‐atrial tachycardia after substrate modification ablation in a low voltage zone of the left atrial anterior wall: Long‐term results

Aims. This study sought to describe left atrial macroreentry tachycardia (LAMRT) originating from the spontaneous scarring of left atrial anterior wall (LAAW) and its clinical and electrophysiological characteristics, mechanisms, and the formation of substrates. Methods and Results. 9 of 123 patients (89% female, age 79.78 ± 5.59 years) had LAMRT originating from the LAAW with no cardiac surgery or prior left atrial (LA) ablation. The mean tachycardia cycle length (TCL) was 241.67 ± 38.00 milliseconds. Spontaneous scars areas and low voltage areas (LVAs) in the LAAW were found in all patients. Successful ablation of the critical isthmus caused termination of the LAMRT and was not inducible in all patients. Arrhythmogenic substrates of LAMRT were the spontaneous scars of LAAW, which matched with the aorta or/and pulmonary artery contact area. The area under the curve (AUC) of age and combination of gender and age for predicting the LAMRT originating from the LAAW were 0.918 and 0.951, respectively, with a cutoff value of ≥73.5 years of age and gender (female) predicting LAMRT with 88.9% sensitivity and 89% specificity. Conclusion. Combination of gender and age provides a simple and useful criterion to distinguish LAMRT from cavotricuspid isthmus- (CTI-) dependent atrial tachycardia in macroreentry atrial tachycardia (MRAT) in patients without a history of surgery or ablation. Aorta or/and pulmonary artery contacting LA may be related to spontaneous scars. Ablation the isthmus eliminated LAMRT in all patients.

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Substrate modification oft left atrial low-voltage-areas: a tailored concept for catheter ablation of atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/eht308.p2335 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P2335-P2335 ◽

Cited By ~ 1

Author(s):

S. Rolf ◽

S. Kircher ◽

P. Sommer ◽

D. Altmann ◽

T. Gaspar ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

Low Voltage ◽

Substrate Modification

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Arrhythmia Termination During Radiofrequency Delivery Improves Outcomes after Catheter Ablation for Persistent and Long Standing Persistent Atrial Fibrillation

Romanian Journal of Cardiology ◽

10.47803/rjc.2021.31.2.335 ◽

2021 ◽

Vol 31 (2) ◽

pp. 335-342

Author(s):

Alexandrina NASTASA ◽

Corneliu IORGULESCU ◽

Stefan BOGDAN ◽

Silvia DEACONU ◽

Stefan PETRE ◽

...

Keyword(s):

Catheter Ablation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Atrial Tachycardia ◽

Pulmonary Veins ◽

Persistent Atrial Fibrillation ◽

Long Term Results ◽

Electrical Shock ◽

Overdrive Pacing

Background: Achieving long-term successful outcomes with catheter ablation (CA) of persistent atrial fi brillation (PsAF) remains a challenge. Multiple attempts to determine effective ablation strategies besides the pulmonary veins (PV) were made but, so far, there is no agreed standard approach and no clear consensus as to which is the best one. Among the most frequently used techniques was ablation of complex atrial fractionated electrograms (CFAE) but studies showed contradictory results. The optimal procedural endpoint also needs further refi nement. Objectives: We sought to evaluate outcomes in regard to patient characteristics and procedural termination. We also aimed to assess whether continuation of antiarrythmic therapy in the blanking period (1 to 3 months after the procedure) influences long term results. Methods: We enrolled consecutive patients with persistent and long-standing PsAF (LS-PsAF) who underwent one or more radiofrequency catheter ablations (RF CA) - pulmonary vein antral isolation (PVAI), followed by CFAE or resultant atrial tachycardia/flutter elimination, were retrospectively analyzed. Procedural objective was tachyarrhythmia (AF or resultant atrial flutters/tachycardias) termination (TT) to sinus rhythm (SR) during RF delivery. If after extensive substrate based or activation guided ablation sinus rhyhtm was not restored, conversion was performed with antiarrhythmic drugs (AAD), overdrive pacing or electrical shock. Screening for arrhythmia recurrence was performed via clinical interview and 48 hours Holter monitoring at 1,3 and 6 months and then every 6 months. Results: The cohort included 94 patients (age 54.5±11.4, 67 (71%) males, CHADSVASc 2.3±2, 11 (12%) LS-PsAF) Acute restoration of sinus rhythm (SR) was achieved in 93.4% of the cases, 43% by ablation of CFAE or resultant atrial tachycardia/fl utter(AT/AFL), 36.2% by electric cardioversion, 7.4% by chemical conversion, 3.1 % overdrive pacing, 3.7 % spontaneuous / mechanical. The long term success rate after a mean of 1.7±0.8 procedures was 59% at a mean follow-up period of 80±28 months. Freedom from AF was significantly higher when arrhythmia termination was obtained during RF delivery (p – 0.003). Short-term use of AAD in the blanking period did not lead to improved long term outcomes. Conclusions: In patients with PsAF and LS-PsAF restoration of sinus rhyhtm during RF delivery for pulmonary vein isolation, ablation of CFAE or resultant atrial tachyarrhythmia predicts long term procedural success. Further research to determine the best strategy to achieve this outcome is necessary.

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New Discovery of Left Atrial Macroreentry Tachycardia: Originating from the Spontaneous Scarring of Left Atrial Anterior Wall

10.21203/rs.3.rs-855985/v1 ◽

2021 ◽

Author(s):

Xuefeng Zhu ◽

Hongxia Chu ◽

Jianping Li ◽

Chunxiao Wang ◽

Wenjing Li ◽

...

Keyword(s):

Pulmonary Artery ◽

Left Atrial ◽

Atrial Tachycardia ◽

Low Voltage ◽

Area Under The Curve ◽

Anterior Wall ◽

Female Age ◽

Gender And Age ◽

History Of ◽

And Gender

Abstract Aims: This study sought to describe originating from the spontaneous scarring of left atrial anterior wall (LAAW) left atrial macroreentry tachycardia (LAMRT) clinical and electrophysiological characteristics, mechanisms, the formation of substrates.Methods and Results: 9 of 123 patients (89% female, age 79.78±5.59 years) had LAMRT originating from the LAAW and no cardiac surgery or prior left atrial (LA) ablation. The mean tachycardia cycle length (TCL) was 241.67±38.00 milliseconds. Spontaneous scars areas and low voltage areas (LVAs) in the LAAW were found in all patients. Successful ablation of the critical isthmus caused terminated of the LAMRT and was not inducible in all patients. Arrhythmogenic substrates of LAMRT were the spontaneous scars of LAAW, which matched with the aorta or/and pulmonary artery contact area. The area under the curve (AUC) of age and combination of gender and age for predicting the LAMRT originating from the LAAW were 0.918 and 0.951, respectively, with a cutoff value of ≥73.5 years of age and gender (female) predicting LAMRT with 88.9% sensitivity and 89% specificity.Conclusion: Combination of gender and age provides a simple and useful criterion to distinguish LAMRT from cavo-tricuspid isthmus (CTI) -dependent atrial tachycardia in macroreentry atrial tachycardia (MRAT) in patients without a history of surgery or ablation. Aorta or/and pulmonary artery contacting LA may be related to spontaneous scars. Ablation the isthmus eliminated LAMRT in all patients.

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Macroreentrant Atrial Tachycardia in Patients without Previous Atrial Surgery or Catheter Ablation: Clinical and Electrophysiological Characteristics of Scar-Related Left Atrial Anterior Wall Reentry

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.12059 ◽

2012 ◽

Vol 24 (4) ◽

pp. 404-412 ◽

Cited By ~ 25

Author(s):

SEIJI FUKAMIZU ◽

HARUMIZU SAKURADA ◽

TAKEKUNI HAYASHI ◽

RINTARO HOJO ◽

KOTA KOMIYAMA ◽

...

Keyword(s):

Catheter Ablation ◽

Left Atrial ◽

Atrial Tachycardia ◽

Anterior Wall

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A Novel Finding of the Atrial Substrate Properties and Long-Term Results of Catheter Ablation in Chronic Atrial Fibrillation Patients with Left Atrial Spontaneous Echo Contrast

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.2011.02170.x ◽

2011 ◽

Vol 23 (3) ◽

pp. 239-246 ◽

Cited By ~ 15

Author(s):

BENY HARTONO ◽

LI-WEI LO ◽

CHEN-CHUAN CHENG ◽

YENN-JIANG LIN ◽

SHIH-LIN CHANG ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

Chronic Atrial Fibrillation ◽

Long Term Results ◽

Spontaneous Echo Contrast ◽

Substrate Properties

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Predictors of early and late left atrial tachycardia and left atrial flutter after catheter ablation of atrial fibrillation: Long-term follow-up

Cardiology Journal ◽

10.5603/cj.a2015.0040 ◽

2015 ◽

Vol 22 (5) ◽

pp. 557-566 ◽

Cited By ~ 6

Author(s):

Maciej Wójcik ◽

Alexander Berkowitsch ◽

Sergey Zaltsberg ◽

Christian W. Hamm ◽

Heinz F. Pitschner ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Flutter ◽

Left Atrial ◽

Atrial Tachycardia ◽

Long Term Follow Up

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New discovery of left atrial macroreentry tachycardia: originating from the spontaneous scarring of left atrial anterior wall

10.22541/au.161887510.05518659/v1 ◽

2021 ◽

Author(s):

zhu xuefeng ◽

hongxia chu ◽

jianping li ◽

chunxiao wang ◽

wenjing li ◽

...

Keyword(s):

Pulmonary Artery ◽

Left Atrial ◽

Atrial Tachycardia ◽

Low Voltage ◽

Area Under The Curve ◽

Anterior Wall ◽

Female Age ◽

Gender And Age ◽

History Of ◽

And Gender

Aims: This study sought to describe originating from the spontaneous scarring of left atrial anterior wall (LAAW) left atrial macroreentry tachycardia (LAMRT) clinical and electrophysiological characteristics, mechanisms, the formation of substrates. Methods and Results: 9 of 123 patients (89% female, age 79.78±5.59 years) had LAMRT originating from the LAAW and no cardiac surgery or prior left atrial (LA) ablation. The mean tachycardia cycle length (TCL) was 241.67±38.00 milliseconds. Spontaneous scars areas and low voltage areas (LVAs) in the LAAW were found in all patients. Successful ablation of the critical isthmus caused terminated of the LAMRT and was not inducible in all patients. Arrhythmogenic substrates of LAMRT were the spontaneous scars of LAAW, which matched with the aorta or/and pulmonary artery contact area. The area under the curve (AUC) of age and combination of gender and age for predicting the LAMRT originating from the LAAW were 0.918 and 0.951, respectively, with a cutoff value of ≥73.5 years of age and gender (female) predicting LAMRT with 88.9% sensitivity and 89% specificity. Conclusion: Combination of gender and age provides a simple and useful criterion to distinguish LAMRT from cavo-tricuspid isthmus (CTI) -dependent atrial tachycardia in macroreentry atrial tachycardia (MRAT) in patients without a history of surgery or ablation. Aorta or/and pulmonary artery contacting LA may be related to spontaneous scars. Ablation the isthmus eliminated LAMRT in all patients.

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