BACKGROUND: Both focal and macroreentrant atrial tachycardia (ATs) can occur after pulmonary vein (PV) isolation for treatment of atrial fibrillation (AF). We report the response to pacing and pharmacologic maneuvers performed in patients with stable focal ATs after segmental PV isolation. OBJECTIVES: The purpose of this study was to determine the mechanism of focal ATs occurring after PV isolation. METHODS: Patients with persistent left AT after cessation of antiarrhythmic drug therapy presented for mapping and ablation. Electroanatomic mapping during AT was performed. Entrainment was performed from multiple right and left atrial sites. Single-beat resetting was performed. Adenosine was infused intravenously to determine the effect on the tachycardia. RESULTS: Five patients (3 men and 2 women; age 65 +/- 10 years) had focal left AT that persisted in response to pacing maneuvers. Four patients had ATs (cycle length 265 +/- 18 ms) that demonstrated focal areas of early activation at the septal aspect of the right lower (3 patients) or right upper (1 patient) PV ostium. Resetting demonstrated a flat-plus increasing curve in two patients. Adenosine was infused with transient AV block and no change to the tachycardia cycle length in three patients. Tachycardias were entrained from multiple left atrial sites. Recordings from the ablation catheter at the critical isthmus typically demonstrated mid-diastolic or long fractionated potentials. One tachycardia with a longer and more variable cycle length (480-598 ms) did not demonstrate fusion during pacing from distant sites. CONCLUSION: Persistent focal left ATs may occur after segmental PV isolation. Many of these tachycardias are caused by a focal reentrant circuit located at the PV ostium; however, focal nonreentrant rhythms also may occur.
BACKGROUND: Both focal and macroreentrant atrial tachycardia (ATs) can occur after pulmonary vein (PV) isolation for treatment of atrial fibrillation (AF). We report the response to pacing and pharmacologic maneuvers performed in patients with stable focal ATs after segmental PV isolation. OBJECTIVES: The purpose of this study was to determine the mechanism of focal ATs occurring after PV isolation. METHODS:Patients with persistent left AT after cessation of antiarrhythmic drug therapy presented for mapping and ablation. Electroanatomic mapping during AT was performed. Entrainment was performed from multiple right and left atrial sites. Single-beat resetting was performed. Adenosine was infused intravenously to determine the effect on the tachycardia. RESULTS: Five patients (3 men and 2 women; age 65 +/- 10 years) had focal left AT that persisted in response to pacing maneuvers. Four patients had ATs (cycle length 265 +/- 18 ms) that demonstrated focal areas of early activation at the septal aspect of the right lower (3 patients) or right upper (1 patient) PV ostium. Resetting demonstrated a flat-plus increasing curve in two patients. Adenosine was infused with transient AV block and no change to the tachycardia cycle length in three patients. Tachycardias were entrained from multiple left atrial sites. Recordings from the ablation catheter at the critical isthmus typically demonstrated mid-diastolic or long fractionated potentials. One tachycardia with a longer and more variable cycle length (480-598 ms) did not demonstrate fusion during pacing from distant sites. CONCLUSION: Persistent focal left ATs may occur after segmental PV isolation. Many of these tachycardias are caused by a focal reentrant circuit located at the PV ostium; however, focal nonreentrant rhythms also may occur.
Authors: Gustavo R Goldenberg; Daniel Burd; Piotr Lodzinski; Giuseppe Stabile; Jacob A Udell; David Newman; Mohammed Shurrab; Eugene Crystal Journal: J Interv Card Electrophysiol Date: 2016-06-29 Impact factor: 1.900
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; Jose Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: J Interv Card Electrophysiol Date: 2012-03 Impact factor: 1.900
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Europace Date: 2018-01-01 Impact factor: 5.214