%0 Journal Article
%T Organized Atrial Tachycardias after Atrial Fibrillation Ablation
%A Sergio Castrejón-Castrejón
%A Marta Ortega
%A Armando Pérez-Silva
%A David Doiny
%A Alejandro Estrada
%A David Filgueiras
%A José L. López-Sendón
%A José L. Merino
%J Cardiology Research and Practice
%D 2011
%I Hindawi Publishing Corporation
%R 10.4061/2011/957538
%X The efficacy of catheter-based ablation techniques to treat atrial fibrillation is limited not only by recurrences of this arrhythmia but also, and not less importantly, by new-onset organized atrial tachycardias. The incidence of such tachycardias depends on the type and duration of the baseline atrial fibrillation and specially on the ablation technique which was used during the index procedure. It has been repeatedly reported that the more extensive the left atrial surface ablated, the higher the incidence of organized atrial tachycardias. The exact origin of the pathologic substrate of these trachycardias is not fully understood and may result from the interaction between preexistent regions with abnormal electrical properties and the new ones resultant from radiofrequency delivery. From a clinical point of view these atrial tachycardias tend to remit after a variable time but in some cases are responsible for significant symptoms. A precise knowledge of the most frequent types of these arrhythmias, of their mechanisms and components is necessary for a thorough electrophysiologic characterization if a new ablation procedure is required. 1. Introduction Organized atrial tachycardias (AT) are a common problem after atrial fibrillation (AF) ablation (post-AF ablation AT—PAFAT). Since the first isolated case reports [1–5], several mechanisms [6] and different times of onset following the index procedure have been reported.A new ablation procedure often solves this arrhythmic problem [5, 7–14]. Nevertheless, this rhythm disorder merits a special attention for different reasons: (1) it has a high incidence and is often very symptomatic, (2) the complexity of the atrial arrhythmogenic substrate, which may be responsible for the frequent concurrence of several types of AT mechanisms in the same patient, (3) the variety of mapping and ablation approaches which have been reported and (4) the fact that PAFATs mechanisms may be linked to the mechanisms responsible for AF maintenance. This paper reviews the incidence, clinical presentation, mechanisms, electrophysiological characterization and ablation of PAFAT. Finally, a brief review of organized ATs presenting during the AF ablation procedure is also provided. 2. Incidence The real incidence of PAFAT cannot be easily extracted from published series because most of them either focused just on left [15–17] or macroreentrant (MR) AT [18, 19], or did not report the incidence of cavotricuspid isthmus-dependent (CTI) atrial flutter, which is responsible for 7–10% [20–22] of all PAFATs. This latter figure is even
%U http://www.hindawi.com/journals/crp/2011/957538/