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AB8-3
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AB8-3 ORGANIZED LEFT ATRIAL TACHYCARDIAS OCCURRING AFTER PULMONARY VEIN ISOLATION Andre Pisapia, MD, Michel Bremondy, MD, Jacques Faure, MD and Ange Ferracci, MD. St. Joseph Hospital, Marseille, France. Background: Pulmonary vein (PV) isolation by radiofrequency (RF) cath- eter ablation techniques is used to prevent recurrences of atrial fibrillation (AF). A classical consequence of PV isolation can be a recurrent organized left atrial tachycardia (LAT) after ablation by RF. This arrhythmia is frequently referred to as “left atrial flutter”. Aim: To assess the incidence of LAT from 6 weeks to 6 months post ablation on a cohort of 298 patients with drug refractory AF followed from May 2002 to October 2005, after an electrical disconnection of PV. Method: 298 consecutive patients mean age (58 10,8) underwent PV isolation performed by linear ostial PV ablation guided by a 3D cartogra- phy system (CARTO by Biosense Webster, Inc) with a 4 mm tip thermo- cool ablation catheter (Navistar Biosense Webster Inc). Results: At 6 months follow-up, we have analysed 175 patients aged from 22 to 80 years (57,27 10,7), 31 women (17,7%) and 144 men (82.3%), divided in : 92 (52,57%) with paroxysmal AF, 30 (17,14%) with persistent AF and 53 ( 30,29%) with chronic AF. 131 patients (74.86%) are in Sinus rhythm (SR), 42 patients (24%) are in AF, LAF or flutter, 2 patients died (1.14%). Recurrent organized LAT with cycle length of 263ms 42ms occurred in 13 cases (7.42%), 2 women and 11 men. 11 patients accepted to undergo a new procedure, 2 refused. Electro anatomic mapping revealed a focal origin from partially reconnected segments of initially isolated PV for 7 (63.63%) patients (located around the left superior PV for 6 patients and around the right superior PV for 1patient), and a macroreentry mech- anism for 4 (36.36%) patients. After 9,3 4,6 months of new procedure, 10 (90.90%) patients are in SR (5 of them with antiaryhthmic drugs), and 1 (0.1%) patient had a recurrence with LAT and AF and underwent an ablation of atrioventricular junction. Conclusions: Recurrent organized LAT is a possible proarrhythmic side effect of linear left atrial lesions, and has a focal origin with reconnected PV ostia for 63.63% of patients, a macroreentrant mechanism is present for 36.36% of patients. Reisolation of PV and linear lesions to treat macro- reentrant tachycardias appear to be sufficient to treat these arrhythmias. AB8-4 THE MECHANISMS AND RADIOFREQUENCY CATHETER ABLATION OF ATRIAL TACHYCARDIA FOLLOWING SURGERY FOR ATRIAL FIBRILLATION Yasushi Miyauchi, MD, Yoshinori Kobayashi, MD, Takashi Nitta, MD, Mitsunori Maruyama, MD, Yuki Iwasaki, MD, Tsutomu Horie, MD, Hiroshi Taniguchi, MD, Akira Ueno, MD, Reiko Okazaki, MD, Meiso Hayashi, MD, Yosuke Ishii, MD, PhD, Hiroto Ohmori, MD, Teppei Yamamoto, MD, Hiroshige Murata, MD, Takao Katoh, MD and Teruo Takano, MD. Nippon Medical School, Tokyo, Japan. Background: Surgery is highly effective in curing atrial fibrillation (AF), with a maintenance rate of sinus rhythm of approximately 90%. However, atrial tachy- cardia (AT) develops in some patients postoperatively and its mechanism has not been examined in detail. We studied the mechanism of the postoperative AT, and determined the feasibility of radiofrequency (RF) catheter ablation in treating it. Methods: Out of 172 consecutive patients who underwent surgery for AF (Radial procedure in 142, Maze III in 13, PV isolation in 8, others in 8), AT developed in 10 patients (5.8%) 2.21.5 months postoperatively. A total of 12 ATs were mapped in the electrophysiologic study. Results: The mechanisms of the ATs were various, including macroreentry either in the LA (LA-Macro, n9) or RA (n1) and focal AT arising from the RA free wall (n1) or the coronary sinus (CS, n1). In 5 of 9 LA-Macro, a residual conduction across the LA posterior incision at the mitral isthmus lesion was observed (LA-Macro type 1). In 3 of those, completion of a block line by RF applications in the CS at the correspond- ing region resulted in termination of the ATs. The mechanism of the other 4 LA-Macro ATs was reentry around the left PVs (LA-Macro type 2). Three of those were eliminated by linear lesions between the LIPV and posterior LA incision (n2), or between the LSPV and LIPV (n1). In the patient with RA macroreentrant AT, the reentry was around the RA free wall incision, and RF applications to the isthmus between the RA and intercaval incisions eliminated the AT. Two focal ATs were ablated at the earliest activation site. In total, 10 of 12 ATs were successfully eliminated by RF catheter ablation. Conclusion: The most frequent mechanism was macroreentry through a residual conduction site due to insufficient cryoablation in the CS or around the PV. RF catheter ablation is effective in this subset of ATs. AB8-5 ATRIAL ARRHYTHMIAS POST ATRICURE RADIOFREQUENCY ABLATION FOR ATRIAL FIBRILLATION: FINDINGS DURING CATHETER ABLATION Oussama Wazni, MD, Mohamed Kanj, MD, Dhanunjaya R. Lakkireddy, MD, Thal Sergio, MD, Kenneth C. Civello, Jr., MD, Dimpi Patel, DO, Subramanya K. Prasad, MD, Marketa Kozeluhova, MD, J. David Burkhardt, MD, Robert A. Schweikert, MD, Walid I. Saliba, MD and Andrea Natale, MD. Cleveland Clinic Foundation, Cleveland, OH. Background: The Atricure bipolar radiofrequency (RF) system is being used for intraoperative ablation of atrial fibrillation (AF). We describe our findings in patients undergoing ablation of recurrent atrial arrhythmias after Atricure RF ablation for atrial fibrillation. Methods and Results: The management and clinical course of consecutive patients with post Atricure arrhythmias refractory to antiarrhythmic drugs between Jan 2003- Dec 2004 are presented. Fifteen patients presented 12 8 months after intraoperative RF ablation with the Atricure for treatment of AF. Three patients underwent the procedure for lone AF with no other surgical indication. Twelve patients underwent another surgical procedure: mitral valve surgery (6 patients) and CABG (6 patients). Seven patients (47%) had recur- rent AF secondary to recovered pulmonary vein ostial conduction. Two pa- tients were documented to have focal atrial tachycardia which was mapped to the coronary sinus in one patient, and to the to the left atrial (LA) septum in another. Two patients had typical cavotricuspid isthmus dependent RA atrial flutter (AFL), one patient had RA incisional AFL and 3 had LA incisional AFL which was mapped around the right pulmonary veins in one patient and around the mitral valve annulus in 2 patients. All patients were treated successfully with radiofrequency ablation. At one-year follow-up all patients were arrhyth- mia free on no antiarrhythmic medications. Conclusion: After Atricure radiofrequency ablation approximately 40% of patients experiencing atrial arrhythmias have AF secondary to PV-LA S16 Heart Rhythm, Vol 3, No 5, May Supplement 2006
Transcript of AB8-3
AB8-3
ORGANIZED LEFT ATRIAL TACHYCARDIAS OCCURRING AFTERPULMONARY VEIN ISOLATIONAndre Pisapia, MD, Michel Bremondy, MD, Jacques Faure, MDand Ange Ferracci, MD. St. Joseph Hospital, Marseille, France.
Background: Pulmonary vein (PV) isolation by radiofrequency (RF) cath-eter ablation techniques is used to prevent recurrences of atrial fibrillation(AF). A classical consequence of PV isolation can be a recurrent organizedleft atrial tachycardia (LAT) after ablation by RF. This arrhythmia isfrequently referred to as “left atrial flutter”.Aim: To assess the incidence of LAT from 6 weeks to 6 months postablation on a cohort of 298 patients with drug refractory AF followed fromMay 2002 to October 2005, after an electrical disconnection of PV.Method: 298 consecutive patients mean age (58 10,8) underwent PVisolation performed by linear ostial PV ablation guided by a 3D cartogra-phy system (CARTO by Biosense Webster, Inc) with a 4 mm tip thermo-cool ablation catheter (Navistar Biosense Webster Inc).Results: At 6 months follow-up, we have analysed 175 patients aged from22 to 80 years (57,27 10,7), 31 women (17,7%) and 144 men (82.3%),divided in : 92 (52,57%) with paroxysmal AF, 30 (17,14%) with persistentAF and 53 ( 30,29%) with chronic AF. 131 patients (74.86%) are in Sinusrhythm (SR), 42 patients (24%) are in AF, LAF or flutter, 2 patients died(1.14%). Recurrent organized LAT with cycle length of 263ms 42msoccurred in 13 cases (7.42%), 2 women and 11 men. 11 patients acceptedto undergo a new procedure, 2 refused. Electro anatomic mapping revealeda focal origin from partially reconnected segments of initially isolated PVfor 7 (63.63%) patients (located around the left superior PV for 6 patientsand around the right superior PV for 1patient), and a macroreentry mech-anism for 4 (36.36%) patients. After 9,3 4,6 months of new procedure, 10(90.90%) patients are in SR (5 of them with antiaryhthmic drugs), and 1(0.1%) patient had a recurrence with LAT and AF and underwent anablation of atrioventricular junction.Conclusions: Recurrent organized LAT is a possible proarrhythmic sideeffect of linear left atrial lesions, and has a focal origin with reconnectedPV ostia for 63.63% of patients, a macroreentrant mechanism is present for36.36% of patients. Reisolation of PV and linear lesions to treat macro-reentrant tachycardias appear to be sufficient to treat these arrhythmias.
AB8-4
THE MECHANISMS AND RADIOFREQUENCY CATHETERABLATION OF ATRIAL TACHYCARDIA FOLLOWING SURGERYFOR ATRIAL FIBRILLATIONYasushi Miyauchi, MD, Yoshinori Kobayashi, MD, TakashiNitta, MD, Mitsunori Maruyama, MD, Yuki Iwasaki, MD,Tsutomu Horie, MD, Hiroshi Taniguchi, MD, Akira Ueno, MD,Reiko Okazaki, MD, Meiso Hayashi, MD, Yosuke Ishii, MD,PhD, Hiroto Ohmori, MD, Teppei Yamamoto, MD, HiroshigeMurata, MD, Takao Katoh, MD and Teruo Takano, MD.Nippon Medical School, Tokyo, Japan.
Background: Surgery is highly effective in curing atrial fibrillation (AF), with amaintenance rate of sinus rhythm of approximately 90%. However, atrial tachy-cardia (AT) develops in some patients postoperatively and its mechanism has notbeen examined in detail. We studied the mechanism of the postoperative AT, anddetermined the feasibility of radiofrequency (RF) catheter ablation in treating it.Methods: Out of 172 consecutive patients who underwent surgery for AF(Radial procedure in 142, Maze III in 13, PV isolation in 8, others in 8), ATdeveloped in 10 patients (5.8%) 2.2�1.5 months postoperatively. A total of12 ATs were mapped in the electrophysiologic study.Results: The mechanisms of the ATs were various, including macroreentryeither in the LA (LA-Macro, n�9) or RA (n�1) and focal AT arising fromthe RA free wall (n�1) or the coronary sinus (CS, n�1). In 5 of 9LA-Macro, a residual conduction across the LA posterior incision at themitral isthmus lesion was observed (LA-Macro type 1). In 3 of those,completion of a block line by RF applications in the CS at the correspond-ing region resulted in termination of the ATs. The mechanism of the other
4 LA-Macro ATs was reentry around the left PVs (LA-Macro type 2).Three of those were eliminated by linear lesions between the LIPV andposterior LA incision (n�2), or between the LSPV and LIPV (n�1). In thepatient with RA macroreentrant AT, the reentry was around the RA freewall incision, and RF applications to the isthmus between the RA andintercaval incisions eliminated the AT. Two focal ATs were ablated at theearliest activation site. In total, 10 of 12 ATs were successfully eliminatedby RF catheter ablation.Conclusion: The most frequent mechanism was macroreentry through aresidual conduction site due to insufficient cryoablation in the CS or aroundthe PV. RF catheter ablation is effective in this subset of ATs.
AB8-5
ATRIAL ARRHYTHMIAS POST ATRICURE RADIOFREQUENCYABLATION FOR ATRIAL FIBRILLATION: FINDINGS DURINGCATHETER ABLATIONOussama Wazni, MD, Mohamed Kanj, MD, Dhanunjaya R.Lakkireddy, MD, Thal Sergio, MD, Kenneth C. Civello, Jr.,MD, Dimpi Patel, DO, Subramanya K. Prasad, MD, MarketaKozeluhova, MD, J. David Burkhardt, MD, Robert A.Schweikert, MD, Walid I. Saliba, MD and Andrea Natale,MD. Cleveland Clinic Foundation, Cleveland, OH.
Background: The Atricure bipolar radiofrequency (RF) system is beingused for intraoperative ablation of atrial fibrillation (AF). We describe ourfindings in patients undergoing ablation of recurrent atrial arrhythmias afterAtricure RF ablation for atrial fibrillation.Methods and Results: The management and clinical course of consecutivepatients with post Atricure arrhythmias refractory to antiarrhythmic drugsbetween Jan 2003- Dec 2004 are presented. Fifteen patients presented 12� 8months after intraoperative RF ablation with the Atricure for treatment of AF.Three patients underwent the procedure for lone AF with no other surgicalindication. Twelve patients underwent another surgical procedure: mitral valvesurgery (6 patients) and CABG (6 patients). Seven patients (47%) had recur-rent AF secondary to recovered pulmonary vein ostial conduction. Two pa-tients were documented to have focal atrial tachycardia which was mapped tothe coronary sinus in one patient, and to the to the left atrial (LA) septum inanother. Two patients had typical cavotricuspid isthmus dependent RA atrialflutter (AFL), one patient had RA incisional AFL and 3 had LA incisional AFLwhich was mapped around the right pulmonary veins in one patient and aroundthe mitral valve annulus in 2 patients. All patients were treated successfullywith radiofrequency ablation. At one-year follow-up all patients were arrhyth-mia free on no antiarrhythmic medications.Conclusion: After Atricure radiofrequency ablation approximately 40% ofpatients experiencing atrial arrhythmias have AF secondary to PV-LA
S16 Heart Rhythm, Vol 3, No 5, May Supplement 2006
