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Acute Effects of Left Atrial Radiofrequency Ablation on Atrial Fibrillation
Author(s) -
SCHARF CHRISTOPH,
ORAL HAKAN,
CHUGH AMAN,
HALL BURR,
GOOD ERIC,
CHEUNG PETER,
PELOSI FRANK,
MORADY FRED
Publication year - 2004
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2004.03390.x
Subject(s) - medicine , atrial flutter , atrial tachycardia , cardiology , atrial fibrillation , p wave , sinus rhythm , tachycardia , ablation , catheter ablation , radiofrequency ablation , cardioversion
Acutely, when left atrial ablation is performed during atrial fibrillation (AF), the AF may persist and require cardioversion, or it may convert to sinus rhythm or to atrial tachycardia/flutter. The prevalence of these acute outcomes has not been described. Methods and Results: Left atrial ablation, usually including encirclement of the pulmonary veins, was performed during AF in 144 patients with drug‐refractory AF. Conversion to sinus rhythm occurred in 19 patients (13%), to left atrial tachycardia in 6 (4%), and to atrial flutter in 6 (4%). In the 6 patients with a focal atrial tachycardia, the mean cycle length was 294 ± 45 ms. The tachycardia arose in the left atrial roof in 3 patients, the left atrial appendage in 2, and the anterior left atrium in 1. In 3 of 6 patients, the focal atrial tachycardia originated in an area that displayed a relatively short cycle length during AF. In 6 patients, AF converted to macroreentrant atrial flutter with a mean cycle length of 253 ± 47 ms, involving the mitral isthmus in 5 patients and the septum in 1 patient. All atrial tachycardias and flutters were successfully ablated with 1 to 15 applications of radiofrequency energy. Conclusion: When left atrial ablation is performed during AF, the AF may convert to atrial tachycardia or flutter in approximately 10% of patients. Focal atrial tachycardias that occur during ablation of AF may be attributable to driving mechanisms that persist after AF has been eliminated, whereas atrial flutter results from incomplete ablation lines. (J Cardiovasc Electrophysiol, Vol. 15, pp. 515‐521, May 2004)