Arrhythmias & electrophysiology
Epicardial Roof-Dependent Macro–Re-Entrant Tachycardia After Ablation of Atrial Fibrillation: Electrophysiological Characteristics and Ablation
Authors' conclusion
Epi-RMATs are not uncommon after roof or posterior wall ablation. An explicable activation pattern with a conduction obstacle in the dome and appropriate entrainment is critical for the diagnosis.
Study context
- Population
- Patients with roof-dependent RMATs after AF ablation
- Participants
- 44 patients45 roof-dependent RMATs
- Exposure
- Epi-RMAT vs endocardial RMAT (endo-RMAT)
- Epi-RMATn = 15
- Outcome
- Prevalence of epi-RMAT
Methodological detailsconsecutive patients, high-density mapping, Posterior wall ablation performed under esophagus deviation in 2 patients
- Consecutive patients
- High-density mapping
- Posterior wall ablation performed under esophagus deviation in 2 patients
Main finding
As reported in the abstract
Epi-RMAT
34.1%
15
- Clockwise re-entry
- 4
- Counterclockwise re-entry
- 9
- Bi-atrial re-entry
- 2
- Pseudofocal activation pattern
- Five (33.3%)
- Mean width of continuous slow or no conduction zone traversing both pulmonary antra
- 21.3 ± 12.3 mm
- Missing cycle length >10% actual cycle length
- 9 (60.0%)
Observational data: associations, not effects.
Further findings
Ablation time
P < 0.001
Floor line ablation
P < 0.001
Electrogram-guided posterior wall ablation
P < 0.001
| Outcome | Epi-RMAT | Endo-RMAT | P value |
|---|---|---|---|
| Electric cardioversion requiredAll endo-RMATs terminated by radiofrequency | 20.0% | — not stated in the abstract | P = 0.032 |
— not stated in the abstract
Recurrence of atrial arrhythmias
- No significant difference between epi-RMAT and endo-RMAT
Original publication
Epicardial Roof-Dependent Macro–Re-Entrant Tachycardia After Ablation of Atrial Fibrillation: Electrophysiological Characteristics and Ablation. JACC Clin Electrophysiol. Published 18 May 2023. doi:10.
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