Ablation of "Background Tachycardia" in Long Standing Atrial Fibrillation: Improving the Outcomes by Unmasking a Residual Atrial Fibrillation Perpetuator
Catheter ablation of long-standing persistent AF (LSAF) remains challenging. Since AF-Nest (AFN) description, we have observed that a stable, protected, fast source firing, namely "Background Tachycardia"(BT), could be hidden beneath the chaotic AF. Following pulmonary vein isolation (PVI)...
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| Veröffentlicht in: | Journal of atrial fibrillation 2017-08, Vol.10 (2), p.1583-1583 |
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| creator | Pachón-M, José Carlos Pachón-M, Enrique I Santillana P, Tomas G Lobo, Tasso Julio Pachón, Carlos Thiene C Pachón-M, Juán Carlos Albornoz V, Remy Nelson Zerpa A, Juán Carlos Ortencio, Felipe Arruda, Mauricio |
| description | Catheter ablation of long-standing persistent AF (LSAF) remains challenging. Since AF-Nest (AFN) description, we have observed that a stable, protected, fast source firing, namely "Background Tachycardia"(BT), could be hidden beneath the chaotic AF. Following pulmonary vein isolation (PVI)+AFN ablation one or more BT may arise or be induced in 30-40% of patients, which could be the culprit forAF maintenance and ablation recurrences.
We studied 114 patients, from 322 sequential LSAF regular ablations, having spontaneous or induced residual BT after EGM-guided PVI+AFN ablation of LSAF; 55.6±11y/o, 97males (85.1%), EF=65.5±8%, LA=42.8±6.7mm. Macroreentrant tachycardias were excluded. Pre-ablationAF 12-leads ECG Digital processing(DP) and spectral analysis(SA) was performed searching for BT before AF ablation and its correlation with BT during ablation.After PVI, 38.1±9 AFN sites/patient and 135 sustained BTs (1-3, 1.2±0.5/patient) were ablated. BT cycle length(CL) was 246.3±37.3ms. In 79 patients presenting suitable DP for SA, the BT-CL was 241.6±34.3ms with intra procedure BT-CL correlation r=0.83/p |
| doi_str_mv | 10.4022/jafib.1583 |
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We studied 114 patients, from 322 sequential LSAF regular ablations, having spontaneous or induced residual BT after EGM-guided PVI+AFN ablation of LSAF; 55.6±11y/o, 97males (85.1%), EF=65.5±8%, LA=42.8±6.7mm. Macroreentrant tachycardias were excluded. Pre-ablationAF 12-leads ECG Digital processing(DP) and spectral analysis(SA) was performed searching for BT before AF ablation and its correlation with BT during ablation.After PVI, 38.1±9 AFN sites/patient and 135 sustained BTs (1-3, 1.2±0.5/patient) were ablated. BT cycle length(CL) was 246.3±37.3ms. In 79 patients presenting suitable DP for SA, the BT-CL was 241.6±34.3ms with intra procedure BT-CL correlation r=0.83/p<0.01. Following BT ablation, AF could not be induced. During FU of 13→60 months(22.8±12m), AF freedom for BT RF(+) vs. BT RF(-) groups were 77.9% vs. 56.4% (p=0.009), respectively. There was no significant complication.
BT ablation following PVI and AFN ablation improved long-term outcomes ofLSAF ablation. BT is likely due to sustained microreentry, protected during AF by entry block. BT can be suspected by spectral analysis of the pre-ablation ECG and is likely one important AF perpetuator by causing electrical resonance of the AFN. This ablation strategy warrants randomized, multicenter investigation.</description><identifier>ISSN: 1941-6911</identifier><identifier>EISSN: 1941-6911</identifier><identifier>DOI: 10.4022/jafib.1583</identifier><identifier>PMID: 29250230</identifier><language>eng</language><publisher>United States: Cardiofront, Inc</publisher><subject>Original Research</subject><ispartof>Journal of atrial fibrillation, 2017-08, Vol.10 (2), p.1583-1583</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2933-284ab5d8eb087c51d76e18e281bba14e948198458ea646689e672bfb53f1f8693</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673289/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673289/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,728,781,785,886,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29250230$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pachón-M, José Carlos</creatorcontrib><creatorcontrib>Pachón-M, Enrique I</creatorcontrib><creatorcontrib>Santillana P, Tomas G</creatorcontrib><creatorcontrib>Lobo, Tasso Julio</creatorcontrib><creatorcontrib>Pachón, Carlos Thiene C</creatorcontrib><creatorcontrib>Pachón-M, Juán Carlos</creatorcontrib><creatorcontrib>Albornoz V, Remy Nelson</creatorcontrib><creatorcontrib>Zerpa A, Juán Carlos</creatorcontrib><creatorcontrib>Ortencio, Felipe</creatorcontrib><creatorcontrib>Arruda, Mauricio</creatorcontrib><title>Ablation of "Background Tachycardia" in Long Standing Atrial Fibrillation: Improving the Outcomes by Unmasking a Residual Atrial Fibrillation Perpetuator</title><title>Journal of atrial fibrillation</title><addtitle>J Atr Fibrillation</addtitle><description>Catheter ablation of long-standing persistent AF (LSAF) remains challenging. Since AF-Nest (AFN) description, we have observed that a stable, protected, fast source firing, namely "Background Tachycardia"(BT), could be hidden beneath the chaotic AF. Following pulmonary vein isolation (PVI)+AFN ablation one or more BT may arise or be induced in 30-40% of patients, which could be the culprit forAF maintenance and ablation recurrences.
We studied 114 patients, from 322 sequential LSAF regular ablations, having spontaneous or induced residual BT after EGM-guided PVI+AFN ablation of LSAF; 55.6±11y/o, 97males (85.1%), EF=65.5±8%, LA=42.8±6.7mm. Macroreentrant tachycardias were excluded. Pre-ablationAF 12-leads ECG Digital processing(DP) and spectral analysis(SA) was performed searching for BT before AF ablation and its correlation with BT during ablation.After PVI, 38.1±9 AFN sites/patient and 135 sustained BTs (1-3, 1.2±0.5/patient) were ablated. BT cycle length(CL) was 246.3±37.3ms. In 79 patients presenting suitable DP for SA, the BT-CL was 241.6±34.3ms with intra procedure BT-CL correlation r=0.83/p<0.01. Following BT ablation, AF could not be induced. During FU of 13→60 months(22.8±12m), AF freedom for BT RF(+) vs. BT RF(-) groups were 77.9% vs. 56.4% (p=0.009), respectively. There was no significant complication.
BT ablation following PVI and AFN ablation improved long-term outcomes ofLSAF ablation. BT is likely due to sustained microreentry, protected during AF by entry block. BT can be suspected by spectral analysis of the pre-ablation ECG and is likely one important AF perpetuator by causing electrical resonance of the AFN. This ablation strategy warrants randomized, multicenter investigation.</description><subject>Original Research</subject><issn>1941-6911</issn><issn>1941-6911</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNptkVFrFDEQxxdRbK2--AEk9EmEq5tkN5v4IJzFauGgou1zmGRn79LuJmeSLdxH6bftrldLBZ9m4P-f38zwL4q3tDypSsY-XkPnzAmtJX9WHFJV0YVQlD5_0h8Ur1K6LkshBKcviwOmWF0yXh4Wd0vTQ3bBk9CR4y9gb9YxjL4ll2A3OwuxdXBMnCer4NfkVwbfuqlZ5uigJ2fORNfvAZ_I-bCN4XaW8wbJxZhtGDARsyNXfoB0MytAfmJy7TgN_4dBfmDcYh4hh_i6eNFBn_DNQz0qrs6-Xp5-X6wuvp2fLlcLyxTnCyYrMHUr0ZSysTVtG4FUIpPUGKAVqkpSJataIohKCKlQNMx0puYd7aRQ_Kj4vOduRzNga9HnCL3eRjdA3OkATv-reLfR63Cra9FwJmfA-wdADL9HTFkPLlmcXvIYxqSpaiSnleT1ZP2wt9oYUorYPa6hpZ6z1H-y1HOWk_nd08MerX_D4_efP525</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Pachón-M, José Carlos</creator><creator>Pachón-M, Enrique I</creator><creator>Santillana P, Tomas G</creator><creator>Lobo, Tasso Julio</creator><creator>Pachón, Carlos Thiene C</creator><creator>Pachón-M, Juán Carlos</creator><creator>Albornoz V, Remy Nelson</creator><creator>Zerpa A, Juán Carlos</creator><creator>Ortencio, Felipe</creator><creator>Arruda, Mauricio</creator><general>Cardiofront, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170801</creationdate><title>Ablation of "Background Tachycardia" in Long Standing Atrial Fibrillation: Improving the Outcomes by Unmasking a Residual Atrial Fibrillation Perpetuator</title><author>Pachón-M, José Carlos ; Pachón-M, Enrique I ; Santillana P, Tomas G ; Lobo, Tasso Julio ; Pachón, Carlos Thiene C ; Pachón-M, Juán Carlos ; Albornoz V, Remy Nelson ; Zerpa A, Juán Carlos ; Ortencio, Felipe ; Arruda, Mauricio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2933-284ab5d8eb087c51d76e18e281bba14e948198458ea646689e672bfb53f1f8693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Original Research</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pachón-M, José Carlos</creatorcontrib><creatorcontrib>Pachón-M, Enrique I</creatorcontrib><creatorcontrib>Santillana P, Tomas G</creatorcontrib><creatorcontrib>Lobo, Tasso Julio</creatorcontrib><creatorcontrib>Pachón, Carlos Thiene C</creatorcontrib><creatorcontrib>Pachón-M, Juán Carlos</creatorcontrib><creatorcontrib>Albornoz V, Remy Nelson</creatorcontrib><creatorcontrib>Zerpa A, Juán Carlos</creatorcontrib><creatorcontrib>Ortencio, Felipe</creatorcontrib><creatorcontrib>Arruda, Mauricio</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of atrial fibrillation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pachón-M, José Carlos</au><au>Pachón-M, Enrique I</au><au>Santillana P, Tomas G</au><au>Lobo, Tasso Julio</au><au>Pachón, Carlos Thiene C</au><au>Pachón-M, Juán Carlos</au><au>Albornoz V, Remy Nelson</au><au>Zerpa A, Juán Carlos</au><au>Ortencio, Felipe</au><au>Arruda, Mauricio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ablation of "Background Tachycardia" in Long Standing Atrial Fibrillation: Improving the Outcomes by Unmasking a Residual Atrial Fibrillation Perpetuator</atitle><jtitle>Journal of atrial fibrillation</jtitle><addtitle>J Atr Fibrillation</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>10</volume><issue>2</issue><spage>1583</spage><epage>1583</epage><pages>1583-1583</pages><issn>1941-6911</issn><eissn>1941-6911</eissn><abstract>Catheter ablation of long-standing persistent AF (LSAF) remains challenging. Since AF-Nest (AFN) description, we have observed that a stable, protected, fast source firing, namely "Background Tachycardia"(BT), could be hidden beneath the chaotic AF. Following pulmonary vein isolation (PVI)+AFN ablation one or more BT may arise or be induced in 30-40% of patients, which could be the culprit forAF maintenance and ablation recurrences.
We studied 114 patients, from 322 sequential LSAF regular ablations, having spontaneous or induced residual BT after EGM-guided PVI+AFN ablation of LSAF; 55.6±11y/o, 97males (85.1%), EF=65.5±8%, LA=42.8±6.7mm. Macroreentrant tachycardias were excluded. Pre-ablationAF 12-leads ECG Digital processing(DP) and spectral analysis(SA) was performed searching for BT before AF ablation and its correlation with BT during ablation.After PVI, 38.1±9 AFN sites/patient and 135 sustained BTs (1-3, 1.2±0.5/patient) were ablated. BT cycle length(CL) was 246.3±37.3ms. In 79 patients presenting suitable DP for SA, the BT-CL was 241.6±34.3ms with intra procedure BT-CL correlation r=0.83/p<0.01. Following BT ablation, AF could not be induced. During FU of 13→60 months(22.8±12m), AF freedom for BT RF(+) vs. BT RF(-) groups were 77.9% vs. 56.4% (p=0.009), respectively. There was no significant complication.
BT ablation following PVI and AFN ablation improved long-term outcomes ofLSAF ablation. BT is likely due to sustained microreentry, protected during AF by entry block. BT can be suspected by spectral analysis of the pre-ablation ECG and is likely one important AF perpetuator by causing electrical resonance of the AFN. This ablation strategy warrants randomized, multicenter investigation.</abstract><cop>United States</cop><pub>Cardiofront, Inc</pub><pmid>29250230</pmid><doi>10.4022/jafib.1583</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| title | Ablation of "Background Tachycardia" in Long Standing Atrial Fibrillation: Improving the Outcomes by Unmasking a Residual Atrial Fibrillation Perpetuator |
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