Antonio Berruezo1, Felipe Bisbal2, Juan Fernández-Armenta2, Naiara Calvo2, José Ángel Cabrera3, Damián Sanchez-Quintana4, David Andreu2, Teresa M de Caralt2, Josep Brugada2, Lluís Mont2. 1. Unitat de Fibril·lació Auricular (UFA), Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. Electronic address: berruezo@clinic.ub.es. 2. Unitat de Fibril·lació Auricular (UFA), Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. 3. Department of Cardiology, Hospital Universitario Quirón-Madrid, Madrid, Spain. 4. Department of Anatomy and Cell Biology, University of Extremadura, Badajoz, Spain.
Abstract
BACKGROUND: Perimitral flutter (PMF) is a common form of left atrial tachycardia after atrial fibrillation (AF) ablation. The mitral isthmus (MI) is the standard ablation target. However, in some cases bidirectional block cannot be achieved. OBJECTIVE: The purpose of this study was to describe the first experience using a transthoracic epicardial (TTE) approach to treat recurrent PMF after prior unsuccessful ablation. METHODS: This is a case series of four patients with recurrence of highly symptomatic drug-refractory PMF (all male, median age 55 years, 3/4 hypertensive, 2/4 persistent AF, median AF period 24 months). Three patients presented with PMF-related tachymyocardiopathy. TTE ablation of MI was performed after a median of two prior endocardial MI and coronary sinus ablation attempts, using an open-tip 3.5-mm irrigated catheter (40 W, 45ºC). Persistent bidirectional block was assessed by activation mapping and differential pacing and was achieved in all patients. RESULTS: No PMF recurrence was observed after median follow-up of 18 months (range 15-22 months; two patients without antiarrhythmic drugs and two with previously ineffective amiodarone). Left ventricular function normalized in all three patients with tachycardiomyopathy. There were no complications related to TTE approach. CONCLUSION: The present study is the first to report the feasibility of a TTE approach for highly symptomatic PMF refractory to endocardial and coronary sinus MI ablation.
BACKGROUND: Perimitral flutter (PMF) is a common form of left atrial tachycardia after atrial fibrillation (AF) ablation. The mitral isthmus (MI) is the standard ablation target. However, in some cases bidirectional block cannot be achieved. OBJECTIVE: The purpose of this study was to describe the first experience using a transthoracic epicardial (TTE) approach to treat recurrent PMF after prior unsuccessful ablation. METHODS: This is a case series of four patients with recurrence of highly symptomatic drug-refractory PMF (all male, median age 55 years, 3/4 hypertensive, 2/4 persistent AF, median AF period 24 months). Three patients presented with PMF-related tachymyocardiopathy. TTE ablation of MI was performed after a median of two prior endocardial MI and coronary sinus ablation attempts, using an open-tip 3.5-mm irrigated catheter (40 W, 45ºC). Persistent bidirectional block was assessed by activation mapping and differential pacing and was achieved in all patients. RESULTS: No PMF recurrence was observed after median follow-up of 18 months (range 15-22 months; two patients without antiarrhythmic drugs and two with previously ineffective amiodarone). Left ventricular function normalized in all three patients with tachycardiomyopathy. There were no complications related to TTE approach. CONCLUSION: The present study is the first to report the feasibility of a TTE approach for highly symptomatic PMF refractory to endocardial and coronary sinus MI ablation.
Authors: Gabriel Cismaru; Radu Rosu; Nihal El Kamar; Lucian Muresan; Mihai Puiu; Marius Andronache; Paul Puie; Roxana Matuz; Gabriel Gusetu; Dana Pop; Petru Adrian Mircea; Dumitru Zdrenghea Journal: Med Princ Pract Date: 2015-07-24 Impact factor: 1.927