The Incidence, Electrophysiological Characteristics and Ablation Outcome of Left Atrial Tachycardias after Pulmonary Vein Isolation Using Three Different Ablation Technologies.

Patrick Leitz,Benjamin Rath,Julian Wolfes,Julia Köbe,Philipp S Lange,Christian Ellermann,Gerrit Frommeyer,Fatih Güner,Florian Reinke,Lars Eckardt,Christian Andresen,Kristina Wasmer

doi:10.3390/jcdd9020050

Patrick Leitz, Benjamin Rath + Show 10 more

Open Access

https://doi.org/10.3390/jcdd9020050

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Abstract

Background: Left atrial tachycardias (LAT) are a well-known outcome of pulmonary vein isolation (PVI). Few data are available on whether the catheter used to perform PVI influences the incidence, as well as the characteristics of post PVI LAT. We present data on LAT following PVI by the following three ablation technologies: (1) phased multi-electrode radiofrequency catheter (PVAC), (2) irrigated single-tip catheter (iRF), and (3) cryoballoon ablation. Methods: Using a prospectively designed single-center database, we analyzed 650 patients (300 iRF, 150 PVAC, and 200 cryoballoon) with paroxysmal (n = 401) and persistent atrial fibrillation (AF), who underwent their first PVI at our center. Results: The three populations were comparable in their baseline characteristics; however, the cryoballoon group comprised a higher percentage of patients with persistent AF (p = 0.05). The LAT rates were 3.7% in the iRF group (mean follow-up 22 ± 14 months), 0.7% in the PVAC group (mean follow-up 21 ± 14 months), and 4% in the cryoballoon group (mean follow-up 15 ± 8 months). The predominant mechanism of LAT was macro-reentrant tachycardia. Reconnection of at least one pulmonary vein was observed in 87% of the patients who underwent 3D mapping. No predictors for LAT occurrence were identified. Conclusion: The occurrence of LAT post PVI is rare; the predominant mechanism was macro-reentrant tachycardia. Reconnection of at least one pulmonary vein was observed in nearly all the LAT patients. In our retrospective analysis, the lowest rate of LAT was observed with the PVAC. No predictors for LAT occurrence were identified.

Highlights

Atrial fibrillation (AF) is the most widespread sustained arrhythmia [1] and a major cause of stroke [2]
A well-known outcome of pulmonary vein isolation (PVI) is the occurrence of left atrial tachycardias (LAT), which are often more symptomatic than the initial atrial fibrillation (AF)
It remains unclear if the technology used for PVI affects the occurrence rates and electrophysiological mechanisms of post PVI Left atrial tachycardias (LAT)

Summary

Introduction

Atrial fibrillation (AF) is the most widespread sustained arrhythmia [1] and a major cause of stroke [2]. Pulmonary vein isolation (PVI) has steadily gained importance in comparison to antiarrhythmic drugs [3,4] Developments such as the cryoballoon and the multipolar phased ablation catheter have allowed for shorter procedural times with comparable efficacy and safety as the established single-tip point-bypoint ablation [5,6]. A well-known outcome of PVI is the occurrence of left atrial tachycardias (LAT), which are often more symptomatic than the initial AF. We sought to determine the occurrence rates, as well as mechanisms, of post PVI LAT after ablation, performed with the following three technical approaches: (1) single-tip irrigated RF catheter (iRF), (2) phased multipolar RF ablation catheter (PVAC), and (3) a cryoballoon system. Left atrial tachycardias (LAT) are a well-known outcome of pulmonary vein isolation (PVI).

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