In:
Journal of Cardiovascular Electrophysiology, Wiley, Vol. 29, No. 2 ( 2018-02), p. 274-283
Abstract:
It is largely believed that atrial tachycardias (ATs) encountered during ablation of persistent atrial fibrillation (PsAF) are a byproduct of ablative lesions. We aimed to explore the alternative hypothesis that they may be a priori drivers of AF remaining masked until other AF sources are reduced or eliminated. Methods and results Radiofrequency ablation of fibrillatory drivers mapped by electrocardiographic imaging (ECGI; ECVUE™, Cardioinsight Technologies, Cleveland, OH, USA) terminated PsAF in 198 (73%) out of 270 patients (61 ± 10 years, 9 ± 9 m). Two hundred and six ATs in 158 patients were subsequently mapped. Their anatomic relationship to the fibrillatory drivers prospectively identified by ECGI was then established. There were 26 (13%), 52 (25%), and 128 (62%) focal, localized, and macrore‐entrant ATs, respectively. In focal/localized re‐entrant ATs, 64 (82%) were terminated within an AF‐driver region, in which 26 (81%) among 32 focal/localized ATs analyzed with 3‐D‐mapping system merged to driver map occurred from AF‐driver regions in 1.0 ± 1.0 cm distance from the driver core. Importantly, there was no attempt at ablation of the associated AF‐driver region in 25 of 64 (39%) of focal/localized re‐entrant ATs. The sites of ATs origin generally had low‐voltage, fractionated, and long‐duration electrograms in AF. All but two focal/localized re‐entrant ATs were successfully ablated. Conclusion The majority of post‐AF‐ablation focal and localized re‐entrant ATs originate from the region of prospectively established AF‐driver regions. A third of these are localized to regions not subsequently submitted to ablation. These data suggest that many ATs exist, although not necessarily manifest independently, prior to ablation. They may have a role in the maintenance of PsAF in these individuals.
Type of Medium:
Online Resource
ISSN:
1045-3873
,
1540-8167
DOI:
10.1111/jce.2018.29.issue-2
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2037519-0
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