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Clinical significance of induced left atrial macro-reentrant tachycardia after pulmonary vein isolation

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Abstract

Background

The clinical significance of induced left atrial macro-reentrant tachycardia (LA-AT) after encircling pulmonary vein isolation (EPVI) is unclear. Our objective was to determine whether induced LA-ATs are associated with the clinical recurrence of ATs.

Methods

We studied 185 consecutive patients with paroxysmal atrial fibrillation (PAF) who underwent their first EPVI with an 8-mm tip, nonirrigated catheter approach. AT was induced by atrial burst pacing after the completion of EPVI, and the atrial activation pattern was evaluated using EnSite NavX. Induced LA-ATs were ablated only in patients with clinical ATs of suspected LA origin. The factors associated with occurrence of AT after the procedure were examined.

Results

LA-ATs were induced in 38 patients and ablated in 5 patients. During a follow-up of 23 ± 7 months, the occurrence of AT did not differ between patients with nonablated LA-ATs (4/33, 12 %) and those without any inducible ATs (16/113, 14 %, p > 0.99). In multivariate analysis, the number of ablation points for completing EPVI was the only independent predictor of AT occurrence (odds ratio 1.07, p < 0.01). A repeat procedure was performed in 22 of 26 patients who developed AT. Nineteen patients became free from AT and AF after ablation of the conduction gaps (EPVI, n = 17; another line, n = 4), extra PV firing (n = 4), focal AT (n = 4), and induced LA-ATs (n = 3).

Conclusions

In patients who had EPVI for PAF using an 8-mm tip, nonirrigated catheter, the occurrence of AT after EPVI was mainly due to conduction gaps in the ablation line or extra PV triggers. In patients with PAF, LA-ATs induced during the first procedure did not require ablation if they were not associated with clinical AT.

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Authors and Affiliations

  1. Department of Cardiology, Saiseikai Izuo Hospital, Kitamura 3-4-5, 551-0032, Taisho-ku, Osaka, Japan

    Hideyuki Hara, Masahiro Yoshinaga, Yumie Matsui, Satoshi Yamamoto, Takahiro Ishido, Kotaro Yutaka & Masahiro Karakawa

  2. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan

    Hideyuki Hara

  3. Nihon Kohden, Co., Ltd., Tokyo, Japan

    Tomonori Kasuu

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  1. Hideyuki Hara
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  2. Masahiro Yoshinaga
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  3. Yumie Matsui
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Correspondence to Hideyuki Hara.

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Hara, H., Yoshinaga, M., Matsui, Y. et al. Clinical significance of induced left atrial macro-reentrant tachycardia after pulmonary vein isolation. J Interv Card Electrophysiol 46, 167–176 (2016). https://doi.org/10.1007/s10840-015-0055-8

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  • DOI: https://doi.org/10.1007/s10840-015-0055-8

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