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 in | Journal of cardiovascular electrophysiology Vol. 26; no. 1; pp. 28 - 35 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Blackwell Publishing Ltd
01.01.2015
Wiley Subscription Services, Inc |
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Online Access | Get full text |
ISSN | 1045-3873 1540-8167 1540-8167 |
DOI | 10.1111/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. |
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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. |
Author_xml | – sequence: 1 givenname: EVGENY N. surname: MIKHAYLOV fullname: MIKHAYLOV, EVGENY N. email: e.mikhaylov@almazovcentre.ru organization: Department of Electrophysiology, Federal Almazov Medical Research Centre, Saint-Petersburg, Russian Federation – sequence: 2 givenname: LUBOV B. surname: MITROFANOVA fullname: MITROFANOVA, LUBOV B. organization: Department of Pathology, Federal Almazov Medical Research Centre, Russian Federation, Saint-Petersburg – sequence: 3 givenname: MARIANNA A. surname: VANDER fullname: VANDER, MARIANNA A. organization: Department of Electrophysiology, Federal Almazov Medical Research Centre, Saint-Petersburg, Russian Federation – sequence: 4 givenname: ROMAN B. surname: TATARSKIY fullname: TATARSKIY, ROMAN B. organization: Department of Electrophysiology, Federal Almazov Medical Research Centre, Russian Federation, Saint-Petersburg – sequence: 5 givenname: ALEXANDER V. surname: KAMENEV fullname: KAMENEV, ALEXANDER V. organization: Department of Electrophysiology, Federal Almazov Medical Research Centre, Saint-Petersburg, Russian Federation – sequence: 6 givenname: MIKHAIL L. surname: ABRAMOV fullname: ABRAMOV, MIKHAIL L. organization: Department of Electrophysiology, Federal Almazov Medical Research Centre, Saint-Petersburg, Russian Federation – sequence: 7 givenname: TAMAS surname: SZILI-TOROK fullname: SZILI-TOROK, TAMAS organization: Department of Cardiology, Rotterdam, Erasmus MC, Netherlands – sequence: 8 givenname: DMITRY S. surname: LEBEDEV fullname: LEBEDEV, DMITRY S. organization: Department of Electrophysiology, Federal Almazov Medical Research Centre, Russian Federation, Saint-Petersburg |
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Keywords | left atrial flutter perimitral reentry atrial fibrillation catheter ablation Bachmann's bundle atrial tachycardia |
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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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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 |
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