Flutter localized to the anterior left atrium after catheter ablation of atrial fibrillation

Pierre Jaïs, Prashanthan Sanders, Li Fern Hsu, Mélèze Hocini, Frederic Sacher, Yoshihide Takahashi, Martin Rotter, Thomas Rostock, Pierre Bordachar, Sylvain Reuter, Julien Laborderie, Jacques Clémenty, Michel Haïssaguerre

Research output: Contribution to journalArticlepeer-review

67 Citations (Scopus)

Abstract

Introduction: Organized atrial arrhythmias following atrial fibrillation (AF) ablation are typically due to recovered pulmonary vein (PV) conduction or reentry at incomplete ablation lines. We describe the role of nonablated anterior left atrium (LA) in arrhythmias observed after AF ablation. Methods: A total of 275 consecutive patients with paroxysmal (n = 200) or chronic (n = 75) AF had PV isolation with/without additional linear ablation at the mitral isthmus (n = 106), LA roof (n = 23), or both (n = 88). Organized arrhythmias occurring after ablation were evaluated utilizing activation and entrainment mapping. Results: Fourteen patients (11 female, 65 ± 13 years, 10 chronic AF, 10 structural heart disease) demonstrated tachycardia localized to the anterior LA, an area not targeted by prior ablation. Eight had ECG features during sinus rhythm suggestive of impaired anterior LA conduction at baseline. These arrhythmias demonstrated a distinctive ECG flutter morphology in 7 of 10 (70%) with discrete -/+ or +/-/+ aspect in inferior leads. Mapping the anterior LA revealed electrograms spanning the entire tachycardia cycle length (325 ± 125 msec). Entrainment was possible in all with a postpacing interval exceeding the tachycardia cycle length by 9 ± 10 msec. Electroanatomic mapping in 6 demonstrated small reentrant circuits rotating clockwise in 4 and counterclockwise in 2. Low-amplitude, fractionated mid-diastolic potentials with long duration (200 ± 80 msec) occupying 63 ± 22% of the cycle length were targeted for ablation resulting in termination and subsequent noninducibility. Conclusion: Organized arrhythmias occurring after AF ablation can be due to reentrant circuits localized to the anterior LA, predominantly in females with chronic AF, structural heart disease, and abnormal atrial conduction. They are characterized by a distinctive surface ECG and highly responsive to RF ablation at the slow conduction area.

Original languageEnglish
Pages (from-to)279-285
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume17
Issue number3
DOIs
Publication statusPublished or Issued - Mar 2006

Keywords

  • Atrium
  • Catheter ablation
  • Fibrillation
  • Flutter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this