Kaige Li, Bosheng Xu, Yang Liu, Xinhua Wang, Bing Han, Ping Ye, Weifeng Jiang, Shaohui Wu, Kai Xu, Zheng Qidong, Yanzhe Wang, Mu Qin, Xu Liu, Xumin Hou
{"title":"Intermediate Atrial Tachycardia During Persistent Atrial Fibrillation Ablation: A Sub-analysis of the Extent-AF Trial.","authors":"Kaige Li, Bosheng Xu, Yang Liu, Xinhua Wang, Bing Han, Ping Ye, Weifeng Jiang, Shaohui Wu, Kai Xu, Zheng Qidong, Yanzhe Wang, Mu Qin, Xu Liu, Xumin Hou","doi":"10.1111/pace.15180","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The evidence supporting additional linear ablation for persistent atrial fibrillation (PerAF) remains limited. This study investigates the mechanisms of intermediate atrial tachycardia (AT), a transient state between PerAF and sinus rhythm (SR), during PerAF termination by catheter ablation, and provides evidence for these mechanisms.</p><p><strong>Methods: </strong>We analyzed 136 patients who converted to organized AT after PerAF termination in the Extent-AF study. Bi-atrial activation mapping combined with entrainment mapping was used to identify the mechanisms and critical isthmus of these ATs.</p><p><strong>Results: </strong>A total of 164 ATs were identified in 136 patients (average 1.2 per patient), with 143 (87%) ATs successfully mapped in 113 patients (average 1.3 per patient). The mechanisms of intermediate ATs included macro-reentry in 110 (77%), micro-reentry in 21 (15%), and focal AT in 12 (8%). Among the macro-reentrant ATs, the most common were perimitral ATs (PM-AT) in 52 (47%), followed by roof-dependent ATs (RF-AT) in 40 (36%) and typical atrial flutter (AFL) in 18 (16%). A total of 98 (72%) patients successfully underwent ablation for intermediate ATs. Of these, 88 (90%) required at least one of the perimitral line, roofline, or peritricuspid line to finally restore SR. After 12 months of follow-up, 63 (64.3%) of the patients with successfully ablated ATs were remained free of arrhythmia.</p><p><strong>Conclusions: </strong>The majority of intermediate ATs after PerAF termination were macro-reentrant ATs. Linear ablation targeting the mitral isthmus, roof, and tricuspid isthmus was crucial for restoring SR in up to 90% of patients, suggesting the importance of additional linear ablation in PerAF ablation.</p><p><strong>Trial registration: </strong>Optimization of intervention strategies for persistent atrial fibrillation: ChiCTR2200060075; chictr.org.cn.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"455-463"},"PeriodicalIF":1.7000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pace-Pacing and Clinical Electrophysiology","FirstCategoryId":"5","ListUrlMain":"https://doi.org/10.1111/pace.15180","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/13 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The evidence supporting additional linear ablation for persistent atrial fibrillation (PerAF) remains limited. This study investigates the mechanisms of intermediate atrial tachycardia (AT), a transient state between PerAF and sinus rhythm (SR), during PerAF termination by catheter ablation, and provides evidence for these mechanisms.
Methods: We analyzed 136 patients who converted to organized AT after PerAF termination in the Extent-AF study. Bi-atrial activation mapping combined with entrainment mapping was used to identify the mechanisms and critical isthmus of these ATs.
Results: A total of 164 ATs were identified in 136 patients (average 1.2 per patient), with 143 (87%) ATs successfully mapped in 113 patients (average 1.3 per patient). The mechanisms of intermediate ATs included macro-reentry in 110 (77%), micro-reentry in 21 (15%), and focal AT in 12 (8%). Among the macro-reentrant ATs, the most common were perimitral ATs (PM-AT) in 52 (47%), followed by roof-dependent ATs (RF-AT) in 40 (36%) and typical atrial flutter (AFL) in 18 (16%). A total of 98 (72%) patients successfully underwent ablation for intermediate ATs. Of these, 88 (90%) required at least one of the perimitral line, roofline, or peritricuspid line to finally restore SR. After 12 months of follow-up, 63 (64.3%) of the patients with successfully ablated ATs were remained free of arrhythmia.
Conclusions: The majority of intermediate ATs after PerAF termination were macro-reentrant ATs. Linear ablation targeting the mitral isthmus, roof, and tricuspid isthmus was crucial for restoring SR in up to 90% of patients, suggesting the importance of additional linear ablation in PerAF ablation.
Trial registration: Optimization of intervention strategies for persistent atrial fibrillation: ChiCTR2200060075; chictr.org.cn.
期刊介绍：
Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
