Atrial Tachycardias After Surgical Atrial Fibrillation Ablation. Clinical Characteristics, Electrophysiological Mechanisms, and Ablation Outcomes From a Large, Multicenter Study

Rakesh Gopinathannair, Philip L. Mar, Muhammad Rizwan Afzal, Luigi Di Biase, Yixi Tu, Thanmay Lakkireddy, Jaimin R. Trivedi, Mark S. Slaughter, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: The clinical characteristics, electrophysiological mechanisms, and ablation outcomes of post-surgical atrial fibrillation ablation (SAFA) atrial tachycardias (ATs) have not been studied in a large, multicenter cohort. Background: ATs are often seen following SAFA. Methods: Analysis was performed on 137 patients (age, 62 ± 10 years; 74% male) who underwent catheter ablation for symptomatic post-SAFA AT from 2004 to 2013 at 3 high-volume institutions in the United States. Results: A total of 137 patients had 149 ATs that were mapped; 103 (69%) had a left atrial (LA) origin and 46 (31%) had a right atrial origin. Of the 149, a total of 44 (30%) had a focal mechanism, with 29 (66%) having an LA origin, with 53% localized to LA posterior wall. Of the 105 re-entrant ATs, 74 (71%) were of LA origin. The predominant circuits were cavotricuspid isthmus (n = 25), perimitral (n = 19), LA roof (n = 17), left pulmonary veins (n = 13), right pulmonary vein/LA septum (n = 12), and LA appendage (n = 7). A total of 93% of patients had ≥1 pulmonary vein reconnection requiring reisolation. Catheter ablation resulted in termination and noninducibility of 97% of right atrial and 93% of LA ATs. Over a 12-month follow-up, 80% of patients were free of any AT or AF. Conclusions: In this large multicenter cohort of post-SAFA ATs, most were of LA origin, with macro-re-entry being the most common arrhythmia mechanism. Wide variability in location of AT circuits was seen in both right atrial and LA and likely reflects underlying arrhythmogenic substrate and differences in modified SAFA techniques. Catheter ablation was highly successful in eliminating the culprit AT with favorable long-term outcomes.

Original languageEnglish (US)
JournalJACC: Clinical Electrophysiology
DOIs
StateAccepted/In press - Nov 7 2016

Fingerprint

Tachycardia
Atrial Fibrillation
Multicenter Studies
Catheter Ablation
Pulmonary Veins
Ablation Techniques
Atrial Septum
Atrial Appendage
Cardiac Arrhythmias

Keywords

  • Atrial flutter
  • Atrial tachycardia
  • Catheter ablation
  • MAZE procedure
  • Surgical atrial fibrillation ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Atrial Tachycardias After Surgical Atrial Fibrillation Ablation. Clinical Characteristics, Electrophysiological Mechanisms, and Ablation Outcomes From a Large, Multicenter Study. / Gopinathannair, Rakesh; Mar, Philip L.; Afzal, Muhammad Rizwan; Di Biase, Luigi; Tu, Yixi; Lakkireddy, Thanmay; Trivedi, Jaimin R.; Slaughter, Mark S.; Natale, Andrea; Lakkireddy, Dhanunjaya.

In: JACC: Clinical Electrophysiology, 07.11.2016.

Research output: Contribution to journalArticle

Gopinathannair, Rakesh ; Mar, Philip L. ; Afzal, Muhammad Rizwan ; Di Biase, Luigi ; Tu, Yixi ; Lakkireddy, Thanmay ; Trivedi, Jaimin R. ; Slaughter, Mark S. ; Natale, Andrea ; Lakkireddy, Dhanunjaya. / Atrial Tachycardias After Surgical Atrial Fibrillation Ablation. Clinical Characteristics, Electrophysiological Mechanisms, and Ablation Outcomes From a Large, Multicenter Study. In: JACC: Clinical Electrophysiology. 2016.
@article{8a355c2cc4e34e3f88a727b5f7df37a5,
title = "Atrial Tachycardias After Surgical Atrial Fibrillation Ablation. Clinical Characteristics, Electrophysiological Mechanisms, and Ablation Outcomes From a Large, Multicenter Study",
abstract = "Objectives: The clinical characteristics, electrophysiological mechanisms, and ablation outcomes of post-surgical atrial fibrillation ablation (SAFA) atrial tachycardias (ATs) have not been studied in a large, multicenter cohort. Background: ATs are often seen following SAFA. Methods: Analysis was performed on 137 patients (age, 62 ± 10 years; 74{\%} male) who underwent catheter ablation for symptomatic post-SAFA AT from 2004 to 2013 at 3 high-volume institutions in the United States. Results: A total of 137 patients had 149 ATs that were mapped; 103 (69{\%}) had a left atrial (LA) origin and 46 (31{\%}) had a right atrial origin. Of the 149, a total of 44 (30{\%}) had a focal mechanism, with 29 (66{\%}) having an LA origin, with 53{\%} localized to LA posterior wall. Of the 105 re-entrant ATs, 74 (71{\%}) were of LA origin. The predominant circuits were cavotricuspid isthmus (n = 25), perimitral (n = 19), LA roof (n = 17), left pulmonary veins (n = 13), right pulmonary vein/LA septum (n = 12), and LA appendage (n = 7). A total of 93{\%} of patients had ≥1 pulmonary vein reconnection requiring reisolation. Catheter ablation resulted in termination and noninducibility of 97{\%} of right atrial and 93{\%} of LA ATs. Over a 12-month follow-up, 80{\%} of patients were free of any AT or AF. Conclusions: In this large multicenter cohort of post-SAFA ATs, most were of LA origin, with macro-re-entry being the most common arrhythmia mechanism. Wide variability in location of AT circuits was seen in both right atrial and LA and likely reflects underlying arrhythmogenic substrate and differences in modified SAFA techniques. Catheter ablation was highly successful in eliminating the culprit AT with favorable long-term outcomes.",
keywords = "Atrial flutter, Atrial tachycardia, Catheter ablation, MAZE procedure, Surgical atrial fibrillation ablation",
author = "Rakesh Gopinathannair and Mar, {Philip L.} and Afzal, {Muhammad Rizwan} and {Di Biase}, Luigi and Yixi Tu and Thanmay Lakkireddy and Trivedi, {Jaimin R.} and Slaughter, {Mark S.} and Andrea Natale and Dhanunjaya Lakkireddy",
year = "2016",
month = "11",
day = "7",
doi = "10.1016/j.jacep.2017.02.018",
language = "English (US)",
journal = "JACC: Clinical Electrophysiology",
issn = "2405-5018",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Atrial Tachycardias After Surgical Atrial Fibrillation Ablation. Clinical Characteristics, Electrophysiological Mechanisms, and Ablation Outcomes From a Large, Multicenter Study

AU - Gopinathannair, Rakesh

AU - Mar, Philip L.

AU - Afzal, Muhammad Rizwan

AU - Di Biase, Luigi

AU - Tu, Yixi

AU - Lakkireddy, Thanmay

AU - Trivedi, Jaimin R.

AU - Slaughter, Mark S.

AU - Natale, Andrea

AU - Lakkireddy, Dhanunjaya

PY - 2016/11/7

Y1 - 2016/11/7

N2 - Objectives: The clinical characteristics, electrophysiological mechanisms, and ablation outcomes of post-surgical atrial fibrillation ablation (SAFA) atrial tachycardias (ATs) have not been studied in a large, multicenter cohort. Background: ATs are often seen following SAFA. Methods: Analysis was performed on 137 patients (age, 62 ± 10 years; 74% male) who underwent catheter ablation for symptomatic post-SAFA AT from 2004 to 2013 at 3 high-volume institutions in the United States. Results: A total of 137 patients had 149 ATs that were mapped; 103 (69%) had a left atrial (LA) origin and 46 (31%) had a right atrial origin. Of the 149, a total of 44 (30%) had a focal mechanism, with 29 (66%) having an LA origin, with 53% localized to LA posterior wall. Of the 105 re-entrant ATs, 74 (71%) were of LA origin. The predominant circuits were cavotricuspid isthmus (n = 25), perimitral (n = 19), LA roof (n = 17), left pulmonary veins (n = 13), right pulmonary vein/LA septum (n = 12), and LA appendage (n = 7). A total of 93% of patients had ≥1 pulmonary vein reconnection requiring reisolation. Catheter ablation resulted in termination and noninducibility of 97% of right atrial and 93% of LA ATs. Over a 12-month follow-up, 80% of patients were free of any AT or AF. Conclusions: In this large multicenter cohort of post-SAFA ATs, most were of LA origin, with macro-re-entry being the most common arrhythmia mechanism. Wide variability in location of AT circuits was seen in both right atrial and LA and likely reflects underlying arrhythmogenic substrate and differences in modified SAFA techniques. Catheter ablation was highly successful in eliminating the culprit AT with favorable long-term outcomes.

AB - Objectives: The clinical characteristics, electrophysiological mechanisms, and ablation outcomes of post-surgical atrial fibrillation ablation (SAFA) atrial tachycardias (ATs) have not been studied in a large, multicenter cohort. Background: ATs are often seen following SAFA. Methods: Analysis was performed on 137 patients (age, 62 ± 10 years; 74% male) who underwent catheter ablation for symptomatic post-SAFA AT from 2004 to 2013 at 3 high-volume institutions in the United States. Results: A total of 137 patients had 149 ATs that were mapped; 103 (69%) had a left atrial (LA) origin and 46 (31%) had a right atrial origin. Of the 149, a total of 44 (30%) had a focal mechanism, with 29 (66%) having an LA origin, with 53% localized to LA posterior wall. Of the 105 re-entrant ATs, 74 (71%) were of LA origin. The predominant circuits were cavotricuspid isthmus (n = 25), perimitral (n = 19), LA roof (n = 17), left pulmonary veins (n = 13), right pulmonary vein/LA septum (n = 12), and LA appendage (n = 7). A total of 93% of patients had ≥1 pulmonary vein reconnection requiring reisolation. Catheter ablation resulted in termination and noninducibility of 97% of right atrial and 93% of LA ATs. Over a 12-month follow-up, 80% of patients were free of any AT or AF. Conclusions: In this large multicenter cohort of post-SAFA ATs, most were of LA origin, with macro-re-entry being the most common arrhythmia mechanism. Wide variability in location of AT circuits was seen in both right atrial and LA and likely reflects underlying arrhythmogenic substrate and differences in modified SAFA techniques. Catheter ablation was highly successful in eliminating the culprit AT with favorable long-term outcomes.

KW - Atrial flutter

KW - Atrial tachycardia

KW - Catheter ablation

KW - MAZE procedure

KW - Surgical atrial fibrillation ablation

UR - http://www.scopus.com/inward/record.url?scp=85020017846&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020017846&partnerID=8YFLogxK

U2 - 10.1016/j.jacep.2017.02.018

DO - 10.1016/j.jacep.2017.02.018

M3 - Article

C2 - 29759784

AN - SCOPUS:85020017846

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

SN - 2405-5018

ER -