Abstract
Introduction: During atrial fibrillation (AF) ablation, it is generally considered that atrial tachycardia (AT) episodes are a consequence of ablation. Objective: To investigate the spatial relationship between localized AT episodes and dispersion/ablation regions during persistent AF ablation procedures. Methods: We analyzed 72 consecutive patients who presented for an index persistent AF ablation procedure guided by the presence of spatiotemporal dispersion of multipolar electrograms. We characterized spontaneous or post-ablation ATs’ mechanism and location in regard to dispersion regions and ablation lesions. Results: In 72 consecutive patients admitted for persistent AF ablation, 128 ATs occurred in 62 patients (1.9 ± 1.1/patient). Seventeen ATs were recorded before any ablation. In a total of 100 ATs with elucidated mechanism, there were 58 localized sources and 42 macro-reentries. A large number of localized ATs arose from regions exhibiting dispersion during AF (n = 49, 84%). Importantly, these ATs’ locations were generally remote from the closest ablation lesion (n = 42, 72%). Conclusions: In patients undergoing a persistent AF ablation procedure guided by the presence of spatiotemporal dispersion of multipolar electrograms, localized ATs originate within dispersion regions but remotely from the closest ablation lesion. These results suggest that ATs represent a stabilized manifestation of co-existing AF drivers rather than ablation-induced arrhythmias.
Highlights
During atrial fibrillation (AF) ablation, it is generally considered that atrial tachycardia (AT) episodes are a consequence of ablation
In support of these contentions, our findings suggest that spatiotemporal dispersion may AF
ATs are commonly observed during an index persistent AF ablation procedure guided by spatiotemporal dispersion
Summary
Multiple groups have recently described patient-tailored, atrial fibrillation (AF) ablation approaches for patients in persistent AF [1,2,3,4,5,6,7]. Regardless of the approach, most authors have reported the frequent occurrence of during or post-ablation atrial tachycardia (AT) episodes [3,8]. The etiology of these ATs, remains unclear. Alternatively, as an arrhythmia relapse requiring reintervention [1,2,3,8]. Supporting the latter contention, a recent study suggested that post-ablation ATs most often originate from regions that were not previously ablated. The authors suggested that post-ablation ATs exist prior to the ablation of AF drivers. We determined the location of localized ATs in regards of regions mapped as “dispersed” during AF
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