1052-208 Left atrial flutter following circumferential pulmonary vein ablation for the treatment of atrial fibrillation

Background: Left atrial appendage thrombus formation is a known major complication of atrial fibrillation and atrial flutter which increases the risk of embolism and stroke. This risk of thrombosis is greatly increased with a lack of anticoagulation. After conversion to a normal sinus rhythm in these arrhythmias, the risk of thrombus formation in the left atrium persists through a phenomenon termed atrial myocardial stunning. Case: We present the case of a patient who previously underwent successful pulmonary vein isolation and was found to be in typical isthmus-dependent atrial flutter with a questionable recurrence of atrial fibrillation. The decision was made to return for atrial flutter ablation and for evaluation of prior pulmonary vein isolation. Initially, a transesophageal echocardiogram showed a normal ejection fraction, biatrial enlargement and no left atrial appendage thrombus. Ablation of the cavotricuspid isthmus was successfully accomplished with documented bidirectional block. A transesophageal echocardiogram probe was still in place prior to planned transseptal puncture for the evaluation of pulmonary veins. A large thrombus was now observed filling the left atrial appendage. Conclusion and Objective: Atrial stunning is a transient atrial contractile dysfunction that occurs whether sinus rhythm is restored spontaneously, electrically, pharmacologically or by ablation. We know after conversion that there is higher propensity to increased spontaneous echogenic contrast and decreased velocities; however, we do not have documented knowledge of exactly how soon after the conversion to a sinus rhythm a thrombus may be seen. We demonstrate a case of acute left atrial appendage thrombus formation immediately following the successful ablation of isthmus-dependent atrial flutter. Our report validates the belief that strategies of not interrupting anticoagulation prior to the conversion of these arrhythmias should be implemented.

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Circumferential left atrial ablation with concomitant segmental pulmonary vein ablation to ensure electrical isolation: A combined approach in the catheter ablation of atrial fibrillation

Heart Rhythm ◽

10.1016/j.hrthm.2005.02.737 ◽

2005 ◽

Vol 2 (5) ◽

pp. S235-S236

Author(s):

Jesse S. Sethi ◽

Bryan T. Piedad ◽

John R. Bullinga ◽

Douglas S. Holmes ◽

Neil E. Bernstein ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Left Atrial ◽

Combined Approach ◽

Electrical Isolation ◽

Pulmonary Vein Ablation ◽

Atrial Ablation

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Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation

EP Europace ◽

10.1093/europace/eul077 ◽

2006 ◽

Vol 8 (8) ◽

pp. 573-582 ◽

Cited By ~ 122

Author(s):

Isabel Deisenhofer ◽

Heidi Estner ◽

Bernhard Zrenner ◽

Juergen Schreieck ◽

Sonja Weyerbrock ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Pulmonary Vein ◽

Left Atrial ◽

Atrial Tachycardia ◽

Pulmonary Vein Ablation

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Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation. Electroanatomic characterization and treatment

ACC Current Journal Review ◽

10.1016/j.accreview.2004.11.034 ◽

2004 ◽

Vol 13 (12) ◽

pp. 43 ◽

Cited By ~ 2

Author(s):

C.E. Mesas ◽

C. Pappone ◽

C.C.E. Lang

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Left Atrial ◽

Atrial Tachycardia ◽

Pulmonary Vein Ablation

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Left Atrial Contractility is Preserved After Successful Circumferential Pulmonary Vein Ablation in Patients with Atrial Fibrillation

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.2007.01086.x ◽

2008 ◽

Vol 19 (4) ◽

pp. 374-379 ◽

Cited By ~ 36

Author(s):

ROSARIO J. PEREA ◽

DAVID TAMBORERO ◽

LLUIS MONT ◽

TERESA M. De CARALT ◽

JOSE T. ORTIZ ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Left Atrial ◽

Pulmonary Vein Ablation

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P674 Epicardial fat volume is associated with the risk of atrial fibrillation recurrence following pulmonary vein isolation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.353 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

L Bordi ◽

I Kovacs ◽

S Z Korodi ◽

R Hodas ◽

T Benedek ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Left Atrial ◽

Epicardial Fat ◽

Left Ventricular Ejection ◽

Recurrence Rates ◽

Af Ablation ◽

Pulmonary Vein Ablation ◽

Af Recurrence

Abstract Funding Acknowledgements Plaqueimage Background Atrial fibrillation (AF) is the most common supraventricular rhythm disturbance and pulmonary vein (PV) isolation has an important role in rhythm control treatment strategies of this disease. Various anatomical and clinical characteristics have been well established as predictors of the risk of recurrence following ablation procedures, but the role of epicardial fat tissue (EFT) in the recurrence of AF has not been elucidated so far. Purpose To investigate the influence of left atrial size and EFT volume in the recurrence of AF after pulmonary vein ablation, during a 6-month follow-up. Methods A total of 40 patients, 52.5% with paroxysmal and 47.5% with chronic AF underwent PV isolation using radiofrequency and cryoablation techniques. EFT was determined using cardiac computed tomography angiography (CCTA) associated with advanced image post-processing techniques. Results In patients who developed AF recurrence at 6 months after AF ablation, the volume of EFT and of left atrium were significantly larger than in the group who maintained sinus rhythm (202.5 ± 64.56 ml vs. 138 ± 55.74 ml, p = 0.01 for EFT, and 149.3 ± 4.66 ml vs. 90.63 ± 5.19 ml, p <0.0001 for left atrial volume, respectively). The left ventricular ejection fraction was significantly lower in patients with AF recurrence (50.25 ± 6.54% vs. 54.22 ± 3.95%, p = 0,04). The analysis of AF recurrence between the two different ablation techniques did not show any difference in recurrence rates between radiofrequency and cryoablation methods (29% vs. 23%, respectively p = 0.73). At the same time, recurrence rates after AF ablation were not influenced by the main cardiovascular risk factors (age, hypertension, dyslipidemia and smoking) and was not associated with different risk scores (CHA2DS2-VASc and HAS-BLED). Conclusion Patients with AF recurrence after pulmonary vein ablation present significantly higher EFT or left atrial volumes compared to patients who maintained sinus rhythm. This indicates the inflammatory mediated response, usually accompanied by an increased amount of EFT, could be associated with the risk of AF recurrence following catheter ablation of the pulmonary veins.

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