Biatrial Tachycardia Following Linear Anterior Wall Ablation for the Perimitral Reentry: Incidence and Electrophysiological Evaluations

Biatrial Reentry After Anterior LA Line Ablation Introduction A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative to mitral isthmus (MI) ablation for perimitral flutter (PMF). Theoretically, the...

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Published inJournal of cardiovascular electrophysiology Vol. 26; no. 1; pp. 28 - 35
Main Authors MIKHAYLOV, EVGENY N., MITROFANOVA, LUBOV B., VANDER, MARIANNA A., TATARSKIY, ROMAN B., KAMENEV, ALEXANDER V., ABRAMOV, MIKHAIL L., SZILI-TOROK, TAMAS, LEBEDEV, DMITRY S.
Format Journal Article
LanguageEnglish
Published United States Blackwell Publishing Ltd 01.01.2015
Wiley Subscription Services, Inc
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ISSN1045-3873
1540-8167
1540-8167
DOI10.1111/jce.12543

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Abstract Biatrial Reentry After Anterior LA Line Ablation Introduction A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative to mitral isthmus (MI) ablation for perimitral flutter (PMF). Theoretically, the AnL can exclude the LA septal wall from the reentrant circle, and lead to involvement of the right atrium (RA) in a tachycardia (AT) mechanism. Methods and Results Among 807 patients undergoing atrial fibrillation ablation, PMF was diagnosed in 28 subjects, and AnL was performed in 13, and MI ablation in 15 cases. In 4 (31%) patients, AnL resulted in abrupt AT cycle length prolongation, which was associated with the development of a clockwise biatrial tachycardia (bi‐AT). The bi‐AT propagated along the lateral and posterior mitral annulus, entered the RA via the coronary sinus, and after activating the RA septum reentered the LA over the Bachmann's bundle. The bi‐AT was terminated by ablation in Bachmann's bundle insertion areas in the RA or LA. No bi‐AT was documented in the MI group. One patient in the AnL group died of stroke in 10 days following the procedure. Anatomic evaluation showed that at the level of the AnL the RA anteroseptal area was separated from the LA by the aortic root, and was free from ablation damage. Conclusion A bi‐AT can develop when an AnL is created for PMF termination. Biatrial entrainment mapping facilitates diagnosis. Termination of the bi‐AT is feasible when ablated from either RA or LA.
AbstractList A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative to mitral isthmus (MI) ablation for perimitral flutter (PMF). Theoretically, the AnL can exclude the LA septal wall from the reentrant circle, and lead to involvement of the right atrium (RA) in a tachycardia (AT) mechanism. Among 807 patients undergoing atrial fibrillation ablation, PMF was diagnosed in 28 subjects, and AnL was performed in 13, and MI ablation in 15 cases. In 4 (31%) patients, AnL resulted in abrupt AT cycle length prolongation, which was associated with the development of a clockwise biatrial tachycardia (bi-AT). The bi-AT propagated along the lateral and posterior mitral annulus, entered the RA via the coronary sinus, and after activating the RA septum reentered the LA over the Bachmann's bundle. The bi-AT was terminated by ablation in Bachmann's bundle insertion areas in the RA or LA. No bi-AT was documented in the MI group. One patient in the AnL group died of stroke in 10 days following the procedure. Anatomic evaluation showed that at the level of the AnL the RA anteroseptal area was separated from the LA by the aortic root, and was free from ablation damage. A bi-AT can develop when an AnL is created for PMF termination. Biatrial entrainment mapping facilitates diagnosis. Termination of the bi-AT is feasible when ablated from either RA or LA.
Biatrial Reentry After Anterior LA Line Ablation Introduction A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative to mitral isthmus (MI) ablation for perimitral flutter (PMF). Theoretically, the AnL can exclude the LA septal wall from the reentrant circle, and lead to involvement of the right atrium (RA) in a tachycardia (AT) mechanism. Methods and Results Among 807 patients undergoing atrial fibrillation ablation, PMF was diagnosed in 28 subjects, and AnL was performed in 13, and MI ablation in 15 cases. In 4 (31%) patients, AnL resulted in abrupt AT cycle length prolongation, which was associated with the development of a clockwise biatrial tachycardia (bi-AT). The bi-AT propagated along the lateral and posterior mitral annulus, entered the RA via the coronary sinus, and after activating the RA septum reentered the LA over the Bachmann's bundle. The bi-AT was terminated by ablation in Bachmann's bundle insertion areas in the RA or LA. No bi-AT was documented in the MI group. One patient in the AnL group died of stroke in 10 days following the procedure. Anatomic evaluation showed that at the level of the AnL the RA anteroseptal area was separated from the LA by the aortic root, and was free from ablation damage. Conclusion A bi-AT can develop when an AnL is created for PMF termination. Biatrial entrainment mapping facilitates diagnosis. Termination of the bi-AT is feasible when ablated from either RA or LA.
Biatrial Reentry After Anterior LA Line Ablation Introduction A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative to mitral isthmus (MI) ablation for perimitral flutter (PMF). Theoretically, the AnL can exclude the LA septal wall from the reentrant circle, and lead to involvement of the right atrium (RA) in a tachycardia (AT) mechanism. Methods and Results Among 807 patients undergoing atrial fibrillation ablation, PMF was diagnosed in 28 subjects, and AnL was performed in 13, and MI ablation in 15 cases. In 4 (31%) patients, AnL resulted in abrupt AT cycle length prolongation, which was associated with the development of a clockwise biatrial tachycardia (bi‐AT). The bi‐AT propagated along the lateral and posterior mitral annulus, entered the RA via the coronary sinus, and after activating the RA septum reentered the LA over the Bachmann's bundle. The bi‐AT was terminated by ablation in Bachmann's bundle insertion areas in the RA or LA. No bi‐AT was documented in the MI group. One patient in the AnL group died of stroke in 10 days following the procedure. Anatomic evaluation showed that at the level of the AnL the RA anteroseptal area was separated from the LA by the aortic root, and was free from ablation damage. Conclusion A bi‐AT can develop when an AnL is created for PMF termination. Biatrial entrainment mapping facilitates diagnosis. Termination of the bi‐AT is feasible when ablated from either RA or LA.
A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative to mitral isthmus (MI) ablation for perimitral flutter (PMF). Theoretically, the AnL can exclude the LA septal wall from the reentrant circle, and lead to involvement of the right atrium (RA) in a tachycardia (AT) mechanism.INTRODUCTIONA left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative to mitral isthmus (MI) ablation for perimitral flutter (PMF). Theoretically, the AnL can exclude the LA septal wall from the reentrant circle, and lead to involvement of the right atrium (RA) in a tachycardia (AT) mechanism.Among 807 patients undergoing atrial fibrillation ablation, PMF was diagnosed in 28 subjects, and AnL was performed in 13, and MI ablation in 15 cases. In 4 (31%) patients, AnL resulted in abrupt AT cycle length prolongation, which was associated with the development of a clockwise biatrial tachycardia (bi-AT). The bi-AT propagated along the lateral and posterior mitral annulus, entered the RA via the coronary sinus, and after activating the RA septum reentered the LA over the Bachmann's bundle. The bi-AT was terminated by ablation in Bachmann's bundle insertion areas in the RA or LA. No bi-AT was documented in the MI group. One patient in the AnL group died of stroke in 10 days following the procedure. Anatomic evaluation showed that at the level of the AnL the RA anteroseptal area was separated from the LA by the aortic root, and was free from ablation damage.METHODS AND RESULTSAmong 807 patients undergoing atrial fibrillation ablation, PMF was diagnosed in 28 subjects, and AnL was performed in 13, and MI ablation in 15 cases. In 4 (31%) patients, AnL resulted in abrupt AT cycle length prolongation, which was associated with the development of a clockwise biatrial tachycardia (bi-AT). The bi-AT propagated along the lateral and posterior mitral annulus, entered the RA via the coronary sinus, and after activating the RA septum reentered the LA over the Bachmann's bundle. The bi-AT was terminated by ablation in Bachmann's bundle insertion areas in the RA or LA. No bi-AT was documented in the MI group. One patient in the AnL group died of stroke in 10 days following the procedure. Anatomic evaluation showed that at the level of the AnL the RA anteroseptal area was separated from the LA by the aortic root, and was free from ablation damage.A bi-AT can develop when an AnL is created for PMF termination. Biatrial entrainment mapping facilitates diagnosis. Termination of the bi-AT is feasible when ablated from either RA or LA.CONCLUSIONA bi-AT can develop when an AnL is created for PMF termination. Biatrial entrainment mapping facilitates diagnosis. Termination of the bi-AT is feasible when ablated from either RA or LA.
Author MITROFANOVA, LUBOV B.
ABRAMOV, MIKHAIL L.
SZILI-TOROK, TAMAS
KAMENEV, ALEXANDER V.
VANDER, MARIANNA A.
MIKHAYLOV, EVGENY N.
TATARSKIY, ROMAN B.
LEBEDEV, DMITRY S.
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Keywords left atrial flutter
perimitral reentry
atrial fibrillation
catheter ablation
Bachmann's bundle
atrial tachycardia
Language English
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Evgeny N. Mikhaylov and Dmitry S. Lebedev report having received consultation and speaking honoraria from Biosense Webster. Other authors: No disclosures.
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Sawhney N, Anand K, Robertson CE, Wurdeman T, Anousheh R, Feld GK: Recovery of mitral isthmus conduction leads to the development of macro-reentrant tachycardia after left atrial linear ablation for atrial fibrillation. Circ Arrhythm Electrophysiol 2011;4:832-837.
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Namdar M, Gentil-Baron P, Sunthorn H, Burri H, Shah D: Postmitral valve replacement biatrial, septal macroreentrant atrial tachycardia developing after perimitral flutter ablation. Circ Arrhythm Electrophysiol 2014;7:171-174.
Takatsuki S, Fukumoto K, Igawa O, Kimura T, Nishiyama N, Aizawa Y, Tanimoto Y, Tanimoto K, Miyoshi S, Fukuda K: Ridge-related reentry: A variant of perimitral atrial tachycardia. J Cardiovasc Electrophysiol 2013;24:781-787.
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Snippet Biatrial Reentry After Anterior LA Line Ablation Introduction A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right...
A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative...
Biatrial Reentry After Anterior LA Line Ablation Introduction A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right...
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StartPage 28
SubjectTerms Action Potentials
Adult
Aged
atrial fibrillation
Atrial Fibrillation - diagnosis
Atrial Fibrillation - physiopathology
Atrial Fibrillation - surgery
Atrial Flutter - diagnosis
Atrial Flutter - epidemiology
Atrial Flutter - physiopathology
Atrial Flutter - surgery
atrial tachycardia
Bachmann's bundle
Cardiac arrhythmia
Cardiology
catheter ablation
Catheter Ablation - adverse effects
Catheters
Electrophysiologic Techniques, Cardiac
Female
Heart Atria - physiopathology
Heart Atria - surgery
Humans
Incidence
left atrial flutter
Male
Middle Aged
Mitral Valve - physiopathology
Mitral Valve - surgery
perimitral reentry
Predictive Value of Tests
Pulmonary Veins - physiopathology
Pulmonary Veins - surgery
Reoperation
Tachycardia, Supraventricular - complications
Tachycardia, Supraventricular - epidemiology
Tachycardia, Supraventricular - physiopathology
Tachycardia, Supraventricular - surgery
Time Factors
Treatment Outcome
Title Biatrial Tachycardia Following Linear Anterior Wall Ablation for the Perimitral Reentry: Incidence and Electrophysiological Evaluations
URI https://api.istex.fr/ark:/67375/WNG-83HCHR7H-K/fulltext.pdf
https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fjce.12543
https://www.ncbi.nlm.nih.gov/pubmed/25215599
https://www.proquest.com/docview/1643336660
https://www.proquest.com/docview/1645773711
Volume 26
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