Approach to atrial tachycardias during atrial fibrillation ablation. - Aggressive therapy of keep ablation to a minimum?-.

摘要

A trial fibrillation (AF) could be initiated by spontaneous focal discharges originating from the pulmonary veins (PV). This important finding has led to the development of PV isolation. Atrial tachycardia (AT) is sometimes associated with patients receiving AF ablation as (1) a conversion to an organized atrial conduction from a disorganized AF episode during the procedure or (2) iatrogenic AT resulting from the ablation procedure, such as from a conduction gap of a circumferential ablation or incomplete linear lesions during the follow-up.After having achieved PV isolation during on-going AF, AF sometimes converts to organized AT or sinus rhythm as a promising result of ablation in patients with not only paroxysmal AF but also persistent AF. However, AF or AT is sometimes inducible by an aggressive pacing protocol, even after successful termination of AF or AT by RF applications.The ablation approach has shifted from PV isolation alone to additional RF applications, such as linear lesions or electro-gram-guided ablation, as a more aggressive strategy because PV isolation alone is reported not to be adequate in patients with persistent AF. Extensive ablation can be associated with the incidence of AT during the procedure or follow-up period.