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Influence of underlying substrate on atrial tachyarrhythmias after pulmonary vein isolation.

Abstract：

BACKGROUND:Recurrent atrial tachyarrhythmias occur as a result of residual atrial arrhythmogenic substrates after atrial fibrillation (AF) ablation. In patients with AF, electrograms with reduced amplitudes indicate diseased myocardium. OBJECTIVE:The purpose of this study was to investigate the association between the distribution of low-voltage areas and the type of induced atrial tachyarrhythmias. METHODS:Our prospective observational study enrolled 152 consecutive AF patients scheduled for an initial ablation (46% persistent AF). After pulmonary vein isolation, voltage mapping was performed during sinus rhythm, and regions with reduced electrogram amplitudes (<0.5 mV) were defined as low-voltage areas. Burst pacing was performed to investigate the inducibility of atrial tachyarrhythmias. RESULTS:Low-voltage areas were more frequently observed in patients with persistent AF than paroxysmal AF (50% vs. 34%, P = .048). A higher proportion of patients with low-voltage areas presented with inducibility of atrial tachyarrhythmias than those without, as follows: AF 70% vs. 16% (P = .0001); perimitral macroreentrant atrial tachycardia (AT) 18% vs. 0% (P = .0001); and roof-dependent macroreentrant AT 13% vs. 0% (P = .01). Investigation into the regional distribution of low-voltage areas revealed that patients with perimitral macroreentrant AT more frequently coincided with low-voltage areas than those without in the septal (100% vs. 18%, P <.0001) and anterior regions (55% vs. 11%, P = .001), and those with roof-dependent AT in the roof (75% vs. 15%, P <.0001) and posterior regions (75% vs. 15%, P = .0001). CONCLUSION:Low-voltage areas are associated with high inducibility of atrial tachyarrhythmias after pulmonary vein isolation. In addition, the distribution of low-voltage areas is specific for each type of macroreentrant AT.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Masuda M,Fujita M,Iida O,Okamoto S,Ishihara T,Nanto K,Kanda T,Shiraki T,Sunaga A,Matsuda Y,Uematsu M

doi

10.1016/j.hrthm.2015.12.029

subject

Has Abstract

pub_date

2016-04-01 00:00:00

pages

870-8

issue

4

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(15)01589-1

journal_volume

13

pub_type

杂志文章

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