Mapping and ablation of left atrial tachycardias occurring after atrial fibrillation ablation

Edward P Gerstenfeld, Francis E Marchlinski
Heart Rhythm: the Official Journal of the Heart Rhythm Society 2007, 4 (3 Suppl): S65-72
Regular left atrial tachycardias are a frequent complication of atrial fibrillation ablation procedures. The arrhythmia mechanism appears to be due to focal pulmonary vein reentry in patients who undergo only electrically guided pulmonary vein isolation. The most common site of origin is the septal and inferior aspect of the right pulmonary veins. Attention to avoiding gaps when ablating along this region will minimize the occurrence of these tachycardias. In patients who also undergo linear left atrial ablation lesions and in patients with significant left atrial disease, macroreentry around the mitral annulus or ipsilateral pulmonary veins is frequently observed. Confirming electrical block across any prophylactic linear lesions (mitral isthmus line, left atrial roof line) likely is important for preventing gap-related proarrhythmic tachycardias. When tachycardias do occur, temporizing with ventricular rate control and cardioversion is initially indicated, as approximately one third of these atrial tachycardias may resolve with time. For tachycardias persisting after ablation, detailed three-dimensional activation and entrainment mapping can facilitate localization of the atrial tachycardia and guide the approach to eliminating the arrhythmias. This review provides a systematic approach to the evaluation, diagnosis, localization, and elimination of left atrial tachycardias occurring after atrial fibrillation ablation.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"