Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2023
Right atrial tachycardia after atrial fibrillation ablation: prevalence, clinical characteristics, electrophysiological mechanisms, and long-term outcomes.
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Peng Xiafeng, Wang Shixin, Ju Weizhu, Yang Gang, Gu Kai, Liu Hailei, Li Mingfang, Chen Hongwu, Wang Jing, Chen Minglong
Аннотация
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.
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.