Impact of previous left atrial ablation procedures on the mechanism of left atrial flutter: A single-centre experience.
high-density mapping system
left atrial flutter
perimitral
reentry
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
16
02
2020
revised:
10
04
2020
accepted:
13
04
2020
pubmed:
22
4
2020
medline:
30
6
2021
entrez:
22
4
2020
Statut:
ppublish
Résumé
Left atrial flutter predominantly occurs after surgical or ablation procedures but this entity has also been recently reported in individuals without previous interventions. The use of high-density electroanatomical mapping-systems (HDM) has improved the understanding of underlying mechanisms beyond entrainment maneuvers and substrate analyses. We aimed to evaluate the mechanism of left atrial (LA) flutters in preablated vs ablation-naïve individuals and sought to assess the efficacy of empiric ablations sets in these groups. We included 55 patients admitted for ablation of LA flutter between July 2017 and August 2019. On the basis of HDM analyses the arrhythmia mechanism was determined with consecutive ablation targeting the suspected critical isthmus. Mean age was 69.8 ± 10.7 years, with 26 of 55 (47.3%) male patients. Thirty-nine (71%) patients had previously undergone LA ablation. Arrhythmia mechanisms differed between preablated and ablation-naïve patients as anatomical structure-related LA flutters (perimitral, roof-dependent, within-pulmonary veins) were more frequent in the preablated cohort compared to ablation-naïve individuals (74.4% vs 43.8%; P = .03). In ablation-naïve patients, most flutters (9 of 16, 56.3%) were related to low-voltage areas at the anterior/posterior wall. Acute termination rates were high (>90%) in both groups. Empirical mitral isthmus or roof lines showed a potential higher success rate in preablated patients. We identified different mechanisms of LA flutters in preablated vs ablation-naïve patients. In ablation-naïve patients, most tachycardias involved low-voltage areas rather than anatomical structures. Using HDM, acute success rates were high. Hypothetical linear ablations were less successful in ablation-naïve individuals, further highlighting the need to identify the specific individual tachycardia mechanism in these patients.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1631-1639Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Bun S-S, Latcu DG, Marchlinski F, Saoudi N. Atrial flutter: more than just one of a kind. Eur Heart J. 2015;36:2356-2363.
Winkle RA, Moskovitz R, Mead RH, et al. Ablation of atypical atrial flutters using ultra high density-activation sequence mapping. J Interv Card Electrophysiol. 2017;48:177-184.
Anter E, Tschabrunn CM, Contreras-Valdes FM, Li J, Josephson MF. Pulmonary vein isolation using the Rhythmia mapping system: verification of intracardiac signals using the Orion mini-basket catheter. Heart Rhythm. 2015;12:1927-1934.
Mantziari L, Butcher C, Kontogeorgis A, et al. Utility of a novel rapid high-resolution mapping system in the catheter ablation of arrhythmias: an initial human experience of mapping the atria and the left ventricle. JACC: Clinical Electrophysiology. 2015;1:411-420.
Siebermair J, Neumann B, Risch F, et al. High-density mapping guided pulmonary vein isolation for treatment of atrial fibrillation-two-year clinical outcome of a single center experience. Sci Rep. 2019;9:8830.
Morady F, Oral H, Chugh A. Diagnosis and ablation of atypical atrial tachycardia and flutter complicating atrial fibrillation ablation. Heart Rhythm. 2009;6:S29-S32.
Verma A, Jiang C-Y, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. New Engl J Med. 2015;372:1812-1822.
Jais P, Shah DC, Haïssaguerre M, et al. Efficacy and safety of septal and left-atrial linear ablation for atrial fibrillation. Am J Cardiol. 1999;84:139R-146R.
Tzeis S, Luik A, Jilek C, et al. The modified anterior line: an alternative linear lesion in perimitral flutter. J Cardiovasc Electrophysiol. 2010;21:665-670.
Jais P, Shah DC, Haïssaguerre M, et al. Mapping and ablation of left atrial flutters. Circulation. 2000;101:2928-2934.
Risse E, Bourier F, Telishevska M, et al. Clinical and electrophysiological characteristics of patients with native atypical atrial flutter (Abstract). J Clin Res Cardiol. 2019;108.
Cosio FG. Atrial flutter, typical and atypical: a review. Arrhythm Electrophysiol Rev. 2017;6:55-62.
Matsuo S, Lim KT, Haissaguerre M. Ablation of chronic atrial fibrillation. Heart Rhythm. 2007;4:1461-1463.
Coffey JO, d'Avila A, Dukkipati S, et al. Catheter ablation of scar-related atypical atrial flutter. Europace. 2013;15:414-419.
Frontera A, Takigawa M, Martin R, et al. Electrogram signature of specific activation patterns: analysis of atrial tachycardias at high-density endocardial mapping. Heart Rhythm. 2018;15:28-37.
Ouyang F, Etnst S, Vogtmann T, et al. Characterization of reentrant circuits in left atrial macroreentrant tachycardia: critical isthmus block can prevent atrial tachycardia recurrence. Circulation. 2002;105:1934-1942.
Davies MJ, Pomerance A. Quantitative study of ageing changes in the human sinoatrial node and internodal tracts. Br Heart J. 1972;34:150-152.
Goette A, Kalman JM, Aguinaga L, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Heart Rhythm. 2017;14:e3-e40.
Chae S, Oral H, Good E, et al. Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation: mechanistic insights, results of catheter ablation, and risk factors for recurrence. J Am Coll Cardiol. 2007;50:1781-1787.
Peng H, Sun Z, Zhang H, Wu Y. Radiofrequency ablation of left atrial flutter mediated with double potentials in a seemingly normally structured heart. Int J Cardiol. 2014;175:522-527.
Melby SJ, Lee AM, Zierer A, et al. Atrial fibrillation propagates through gaps in ablation lines: implications for ablative treatment of atrial fibrillation. Heart Rhythm. 2008;5:1296-1301.
Giehm-Reese M, Lukac P, Kristiansen SB, et al. Outcome after catheter ablation for left atrial flutter. Scand Cardiovasc J. 2019;53:133-140.
Sundaram S, Choe W, Ryan Jordan J, et al. Catheter ablation of atypical atrial flutter: a novel 3D anatomic mapping approach to quickly localize and terminate atypical atrial flutter. J Interv Card Electrophysiol. 2017;49:307-318.