Arrhythmias & electrophysiologyCohort study
Incidence, Mechanistic Insights, and Ablation of Atrial Tachycardia Occurring After Pulsed Field Ablation for Atrial Fibrillation
- Retrospective analysis of patients referred for repeat ablation
- high-density electroanatomical mapping
Authors' conclusion
The incidence of repeat ablation for AT after pentaspline PFA was low, likely reflecting the high durability of the index lesion sets. Most post-PFA ATs manifested as dual-loop LA re-entry. Retrospective application of the topological framework provided coherent mechanistic interpretations of AT behavior and accurately predicted the response to direct and indirect critical boundary-targeted ablation.
Study context
- Population
- Patients referred for repeat ablation for atrial tachycardia (AT) after first-time atrial fibrillation ablation with a pentaspline pulsed field ablation (PFA) catheterunderwent repeat ablation among 4,144 patients, final cohort · repeat ablation for atrial fibrillation 160 · repeat ablation for AT 76
- Participants
- 236 patients
Main finding
As reported in the abstract
Repeat ablation for atrial fibrillation (of 4,144 patients)
160 [3.9%]
Repeat ablation for AT (of 4,144 patients)
76 [1.8%]
Observational data: associations, not effects.
Further findings
ATs mapped
- Total ATs mapped
- 87
- Right atrium
- 21 (4 focal and 17 peri-tricuspid valve re-entry)
- Left atrium
- 66 (1 focal and 65 re-entry)
Lesion durability
- Pulmonary vein isolation durability
- 84%
- Posterior wall isolation durability
- 89%
Left atrial (LA) re-entry mechanisms
- Single-loop re-entry
- n = 9
- Dual-loop re-entry
- n = 56
- Dual-loop: circuits defined by anatomical boundaries
- n = 32
- Dual-loop: involving an anterior scar
- n = 24
Response to ablation of LA re-entrant AT
- Sinus rhythm restored in all cases when ablation connected the 2 critical boundaries
- Topological principles accurately explained the observed activation patterns and responses to ablation
Original publication
Summarised from the published abstract; every number is checked against it