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Right atrial tachycardia after atrial fibrillation ablation: prevalence, clinical characteristics, electrophysiological mechanisms, and long-term outcomes

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Abstract

Background

This study aims to evaluate the prevalence, clinical characteristics, electrophysiological mechanisms, and long-term outcomes of right atrial tachycardia (AT) in patients who underwent ablation for atrial fibrillation (AF).

Methods

From March 2010 to December 2020, 220 consecutive patients undergoing index AF ablation were referred for post-ablation AT recurrence. Thirty-five patients (35/220, 15.9%) with right AT recurrence (25 men; mean age 59.3 ± 10.2 years) were enrolled. These patients were divided into groups with right ATs exclusively (group 1) and right combined with left ATs (group 2).

Results

Fifty-three ATs were mapped in all patients, with thirty-nine ATs originating from the right atrium. The detailed distribution of all right ATs was 22 in the cavo-tricuspid isthmus (CTI), 6 in the ostium of superior vein cava (SVC), 4 in the right free wall, 4 in the right anterior atrial septum, 2 in coronary sinus ostium, and 1 in crista terminalis. Group 2 had a significantly higher incidence of typical atrial flutter (AFL) than group 1 (11/12, 90.9% vs. 12/24, 50.0%, P = 0.03). During the mean follow-up of 43.6 ± 25.2 months after the index AT ablation, the recurrence rate of AT/AF was 22.9% (8/35), and it was lower in group 1 than in group 2 (8.3% vs. 54.5%, P = 0.01).

Conclusion

Right AT is relatively less common post-AF ablation. The CTI-dependent AFL and the ostium of SVC-derived focal AT constituted the major components of right ATs, suggesting the importance of ablation- and anatomy-related arrhythmogenic effects in the right atrium.

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Data Availability

Data available on request from the authors.

Abbreviations

AT:

Atrial tachycardia

AF:

Atrial fibrillation

AFL:

Atrial flutter

CFE:

Complex fractionated electrogram

CPVI:

Pulmonary vein isolation

CSO:

Coronary sinus ostium

CT:

Crista terminalis

CTI:

Cavo-tricuspid isthmus

ECG:

Electrocardiogram

LA:

Left atrium

LAD:

Left atrial diameter

LPV:

Left pulmonary vein

MI:

Mitral isthmus

NSR:

Sinus rhythm

PVs:

Pulmonary veins

RA:

Right atrium

RFW:

Right free wall

SVC:

Superior vein cava

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Funding

This study was supported by the Special Foundation for Clinical Science and Technology of Jiangsu Province (Grant number [BE2017754]).

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Author notes

  1. Xiafeng Peng and Shixin Wang contibuted equally to this work.

Authors and Affiliations

  1. Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China

    Xiafeng Peng, Shixin Wang, Weizhu Ju, Gang Yang, Kai Gu, Hailei Liu, Mingfang Li, Hongwu Chen, Jing Wang & Minglong Chen

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  1. Xiafeng Peng
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Correspondence to Hongwu Chen or Jing Wang.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local ethics committee.

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Written informed consent was obtained from each patient.

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The authors declare no competing interests.

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Peng, X., Wang, S., Ju, W. et al. Right atrial tachycardia after atrial fibrillation ablation: prevalence, clinical characteristics, electrophysiological mechanisms, and long-term outcomes. J Interv Card Electrophysiol 66, 1641–1650 (2023). https://doi.org/10.1007/s10840-023-01482-3

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  • DOI: https://doi.org/10.1007/s10840-023-01482-3

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