Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter

Background: Left atrial flutter following atrial fibrillation (AF) ablation is increasingly common and difficult to treat. We evaluated the safety and efficacy of ablation of the anteroseptal line connecting the right superior pulmonary vein (RSPV) to the anteroseptal mitral annulus (MA) for the tre...

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Main Authors: Bernard Abi-Saleh, MD, FACP, FACC, FHRS, Hadi Skouri, MD, Daniel J. Cantillon, MD, FHRS, Jeffery Fowler, DO, Oussama Wazni, MD, FHRS, Patrick Tchou, MD, FHRS, Walid Saliba, MD, FHRS
Format: Article
Language:English
Published: Wiley 2015-12-01
Series:Journal of Arrhythmia
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S1880427615000836
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spelling doaj-e314bb653e65431193aed7c179ae5b792020-11-24T22:18:57ZengWileyJournal of Arrhythmia1880-42762015-12-0131635936310.1016/j.joa.2015.06.001Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutterBernard Abi-Saleh, MD, FACP, FACC, FHRS0Hadi Skouri, MD1Daniel J. Cantillon, MD, FHRS2Jeffery Fowler, DO3Oussama Wazni, MD, FHRS4Patrick Tchou, MD, FHRS5Walid Saliba, MD, FHRS6Department of Internal Medicine (Cardiology Division/Cardiac Electrophysiology Section), American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, LebanonDepartment of Internal Medicine (Cardiology Division/Cardiac Electrophysiology Section), American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, LebanonRobert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USARobert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USARobert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USARobert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USARobert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USABackground: Left atrial flutter following atrial fibrillation (AF) ablation is increasingly common and difficult to treat. We evaluated the safety and efficacy of ablation of the anteroseptal line connecting the right superior pulmonary vein (RSPV) to the anteroseptal mitral annulus (MA) for the treatment of perimitral flutter (PMF). Methods: We systematically studied patients who were previously treated with AF ablation and who presented to the electrophysiology laboratory with atrial tachyarrhythmias between January 2000 and July 2010. The diagnosis of PMF was confirmed by activation mapping and/or entrainment. After re-isolation of any recovered pulmonary vein, a linear radiofrequency (RF) ablation was performed on the line that connected the RSPV to the anteroseptal MA. In this analysis, we included only patients who were treated with an anteroseptal line for their PMF. Results: Ablation was performed at the anteroseptal line in 27 PMF patients (63±13 years; 9 women) who had undergone prior ablation for paroxysmal (n=3) or persistent (n=24) AF, using electroanatomic activation mapping (70% CARTO, 30% NavX). The anteroseptal ablation line was effective in 22/27 (81.5%) patients in the acute-care setting. Termination of AF to sinus rhythm occurred in 15/22 (68.2%) patients, and 7/22 (31.8%) patients׳ AF converted to another right or left atrial flutter. At the 6-month follow-up, 20% of patients demonstrated recurrent left atrial tachyarrhythmia. Only one patient required repeat ablation, and the remaining patients׳ condition was controlled with antiarrhythmic medications. No major procedural complications or heart block occurred. Conclusion: Ablation at the left atrial anteroseptal line is safe and efficacious for the treatment of PMF. Unlike ablation at the traditional mitral isthmus line, ablation at the left atrial anteroseptal line does not require ablation in the coronary sinus.http://www.sciencedirect.com/science/article/pii/S1880427615000836Perimitral flutterAtrial fibrillationAblationLeft atrial anteroseptal line
collection DOAJ
language English
format Article
sources DOAJ
author Bernard Abi-Saleh, MD, FACP, FACC, FHRS
Hadi Skouri, MD
Daniel J. Cantillon, MD, FHRS
Jeffery Fowler, DO
Oussama Wazni, MD, FHRS
Patrick Tchou, MD, FHRS
Walid Saliba, MD, FHRS
spellingShingle Bernard Abi-Saleh, MD, FACP, FACC, FHRS
Hadi Skouri, MD
Daniel J. Cantillon, MD, FHRS
Jeffery Fowler, DO
Oussama Wazni, MD, FHRS
Patrick Tchou, MD, FHRS
Walid Saliba, MD, FHRS
Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter
Journal of Arrhythmia
Perimitral flutter
Atrial fibrillation
Ablation
Left atrial anteroseptal line
author_facet Bernard Abi-Saleh, MD, FACP, FACC, FHRS
Hadi Skouri, MD
Daniel J. Cantillon, MD, FHRS
Jeffery Fowler, DO
Oussama Wazni, MD, FHRS
Patrick Tchou, MD, FHRS
Walid Saliba, MD, FHRS
author_sort Bernard Abi-Saleh, MD, FACP, FACC, FHRS
title Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter
title_short Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter
title_full Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter
title_fullStr Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter
title_full_unstemmed Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter
title_sort efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter
publisher Wiley
series Journal of Arrhythmia
issn 1880-4276
publishDate 2015-12-01
description Background: Left atrial flutter following atrial fibrillation (AF) ablation is increasingly common and difficult to treat. We evaluated the safety and efficacy of ablation of the anteroseptal line connecting the right superior pulmonary vein (RSPV) to the anteroseptal mitral annulus (MA) for the treatment of perimitral flutter (PMF). Methods: We systematically studied patients who were previously treated with AF ablation and who presented to the electrophysiology laboratory with atrial tachyarrhythmias between January 2000 and July 2010. The diagnosis of PMF was confirmed by activation mapping and/or entrainment. After re-isolation of any recovered pulmonary vein, a linear radiofrequency (RF) ablation was performed on the line that connected the RSPV to the anteroseptal MA. In this analysis, we included only patients who were treated with an anteroseptal line for their PMF. Results: Ablation was performed at the anteroseptal line in 27 PMF patients (63±13 years; 9 women) who had undergone prior ablation for paroxysmal (n=3) or persistent (n=24) AF, using electroanatomic activation mapping (70% CARTO, 30% NavX). The anteroseptal ablation line was effective in 22/27 (81.5%) patients in the acute-care setting. Termination of AF to sinus rhythm occurred in 15/22 (68.2%) patients, and 7/22 (31.8%) patients׳ AF converted to another right or left atrial flutter. At the 6-month follow-up, 20% of patients demonstrated recurrent left atrial tachyarrhythmia. Only one patient required repeat ablation, and the remaining patients׳ condition was controlled with antiarrhythmic medications. No major procedural complications or heart block occurred. Conclusion: Ablation at the left atrial anteroseptal line is safe and efficacious for the treatment of PMF. Unlike ablation at the traditional mitral isthmus line, ablation at the left atrial anteroseptal line does not require ablation in the coronary sinus.
topic Perimitral flutter
Atrial fibrillation
Ablation
Left atrial anteroseptal line
url http://www.sciencedirect.com/science/article/pii/S1880427615000836
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