The efficacy of class III D,L sotalol in treatment of left atrial tachycardia after pulmonary vein isolation

Pitvarfibrilláció miatt végzett pulmonalis vena izolációját követően a betegek egy részénél iatrogén bal pitvari tachycardia jelentkezik. Cél: A sotalolterápia hatásosságának összehasonlítása az 1C tip. propafenonnal szemben, a postablatiós arrhythmiák kezelésében. Módszer és eredmények: A vizsgálatba 75, pitvarfibrillációban szenvedő beteget (átlagéletkor 55,4 ± 7,14 év) választottunk, akiknél a pulmonalis vénák valódi elektromos izolálását végeztük. A beavatkozás során az elektromos izolációt körkörös multipoláris katéterrel ellenőriztük. Az ablatiót követően folytattuk az antiarrhythmiás terápiát még minimum 6 hétig, de célunk annak leépítése volt. Az utánkövetést 1, majd 3 havonta tervezett, ambuláns vizsgálatok alapján végeztük. A 12. hónap végén 67 betegnél tudtuk a protokoll szerint gyűjtött adatokat elemezni. 21 betegnél jelentkezett 3 hónapot követően tartósan bal pitvari tachycardia (31,3%). 11 beteg propafenon-, 4 beteg amiodaron- és 6 beteg sotalolterápiában részesült. Az első két csoportnál sotalolterápiára váltottunk, míg az utolsó csoportnál propafenonterápiát kezdtünk. A 12. hónap végére a sotalol hatásossága 80%, a propafenon hatásossága 20% volt. Következtetések: Adataink alapján PV-izolációt követően a sotalolterápia nem hatásosabb a bal pitvari tachycardiák megelőzésében, mint a propafenon. A 3 hónapon túl fellépő postablatiós bal pitvari tachycardiák kezelésében a sotalol hatásosabb, mint az IC-csoportba tartozó propafenon.

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Left Atrial Tachycardia After Pulmonary Vein Isolation for Atrial Fibrillation

Journal of Arrhythmia ◽

10.1016/s1880-4276(05)80016-x ◽

2005 ◽

Vol 21 (5) ◽

pp. 536-541

Author(s):

Kenichi Hashimoto ◽

Ichiro Watanabe ◽

Masayoshi Kofune ◽

Sonoko Ashino ◽

Yasuo Okumura ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Atrial Tachycardia

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Treatment of Sustained Left Atrial Tachycardia by Ostial Pulmonary Vein Isolation

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2004.00600.x ◽

2004 ◽

Vol 27 (8) ◽

pp. 1153-1157

Author(s):

BENGT HERWEG ◽

ARZU ILERCIL ◽

DAVID M. WHITAKER ◽

LYN HAMILTON ◽

NADIM G. KHAN ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Atrial Tachycardia

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Lower rate of left atrial tachycardia after pulmonary vein isolation with PVAC versus irrigated-tip circumferential antral ablation

Heart Rhythm ◽

10.1016/j.hrthm.2016.02.017 ◽

2016 ◽

Vol 13 (8) ◽

pp. 1596-1601 ◽

Cited By ~ 6

Author(s):

Kristina Wasmer ◽

David Krüsemann ◽

Patrick Leitz ◽

Fatih Güner ◽

Christian Pott ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Atrial Tachycardia

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Benefit of ultra-high-density mapping-guided radiofrequency reablation in pulmonary vein isolation non-responders after initial cryoballoon procedure

EP Europace ◽

10.1093/europace/euaa055 ◽

2020 ◽

Vol 22 (6) ◽

pp. 906-915

Author(s):

Florian Straube ◽

Uwe Dorwarth ◽

Stefan Hartl ◽

Benedikt Brueck ◽

Janis Pongratz ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Atrial Tachycardia ◽

Antiarrhythmic Drugs ◽

High Density ◽

Right Atrial ◽

Atrial Arrhythmias ◽

Electroanatomical Mapping ◽

Septal Wall

Abstract Aims Symptomatic atrial arrhythmias despite complete pulmonary vein isolation (PVI) are common. The purpose was to evaluate ultra-high-density multi-electrode electroanatomical mapping-guided radiofrequency ablation (RFA) in PVI non-responders. Methods and results Ultra-high-density multi-electrode electroanatomical mapping-guided RFA in consecutive symptomatic atrial fibrillation (AF) patients after initial cryoballoon PVI was performed. Patients were included if all pulmonary veins (PVs) were still isolated. Radiofrequency targets were atrial tachycardia (AT), extra-PV trigger, and/or substrate. Procedural results and outcome were evaluated. Of 95 patients, 67 (70.5%) with complete PVI were included (70 years, CHA2DS2Vasc 2.9, left atrium 45 mm, persistent AF 45%, AT 45%). The median time to reablation was 26 months. One hundred and seven maps (1.6/patient) and 11.890 ± 9.018 electrograms were acquired in 33 ± 12 min. Twenty-eight percent of the left atrial (LA) wall showed pathological voltage signals, predominantly at the anterior (37%) and septal wall (26%). Atrial tachycardia (49 left, 4 right) were ablated in 35 patients (52%), extra-PV trigger in two patients (3%). One atrioventricular nodal re-entry tachycardia and seven right atrial isthmus ablation (10%) were performed. In 32 patients (48%), no AT was present and substrate-based ablation was performed. Mean LA area ablated was 7 ± 6 cm2 (7%). No major complication occurred. The mean follow-up time was 772 ± 317 days. Freedom from atrial arrhythmia recurrence off antiarrhythmic drugs was 49% at 12 months. Conclusion Pulmonary vein isolation non-responders are older, mainly suffering from complex atrial arrhythmias. Left atrial substrate is predominantly located at the anterior and septal wall. Ultra-high-density multi-electrode electroanatomical mapping-guided RFA is safe and effective. At 1 year, 5 out of 10 patients were in stable sinus rhythm off antiarrhythmic drugs.

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Successful ablation of macroreentrant left atrial tachycardia after pulmonary vein isolation in a patient with cor triatriatum

Heart Rhythm ◽

10.1016/j.hrthm.2013.10.001 ◽

2014 ◽

Vol 11 (8) ◽

pp. 1487-1488 ◽

Cited By ~ 2

Author(s):

Michael T. Spooner ◽

Michael L. Main ◽

Alan P. Wimmer

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Atrial Tachycardia ◽

Cor Triatriatum ◽

Successful Ablation

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Successful Ablation of Roof Dependent Left Atrial Tachycardia Using Cryoballoon After Pulmonary Vein Isolation.

10.22541/au.160843121.13444290/v1 ◽

2020 ◽

Author(s):

Kudret Aytemir ◽

Burak Sezenoz ◽

Ugur Canpolat ◽

Hikmet Yorgun

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Atrial Tachycardia ◽

Left Atrial Appendage ◽

Posterior Wall ◽

Atrial Appendage ◽

Established Method ◽

Left Atrial Appendage Isolation

Cryoballoon technology is a well-established method to provide pulmonary vein isolation in the treatment of atrial fibrillation. Additional lesions such as roof line, posterior wall isolation or left atrial appendage isolation also possible with the same technique. We report a case with roof dependent atrial tachycardia successully terminated by using cryoballoon following pulmonary vein isolation.

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