Organised Atrial Arrhythmias after Atrial Fibrillation Ablation in the Left Atrium (Example 1): an Arrhythmogenic Incomplete Linear Lesion with Modified Left-to-right Atrial Propagation


This is a 61-year-old male patient with hypertension and only mild dilatation of the left atrium. At the age of 54, he underwent ablation for typical atrial flutter with complete bidirectional block of cavotricuspid isthmus conduction. Three years later, in another hospital, he underwent electrophysiologically guided pulmonary-vein isolation for recurrent atrial fibrillation refractory to multiple antiarrhythmic drugs and, during the same hospital stay, three ablation procedures were performed. The ablation strategy included a linear lesion between the mitral annulus and the right superior pulmonary vein os. In the months following ablation, atrial fibrillation did not recur, but the patient did experience episodes of palpitation. ECG documented atrial tachycardia with a stable cycle length of 280 ms and flat P wave morphology in all leads, except V1, which showed a distinct positive P wave (Fig. 1). In the month before undergoing the procedure described below, the arrhythmia became persistent, was poorly tolerated and required electrical cardioversion. Upon arrhythmia recurrence, the patient was hospitalised to undergo an electrophysiologic procedure.


Atrial Fibrillation Pulmonary Vein Left Atrium Atrial Tachycardia Atrial Activation 
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  1. 1.
    Villacastin J, Perez-Castellano N, Moreno J, Gonzales R. Left atrial flutter after radiofrequency catheter ablation of focal atrial fibrillation. J Cardiovasc Electrophysiol 2003; 14: 417–421.PubMedCrossRefGoogle Scholar
  2. 2.
    Mesas CE, Pappone C, Lang CCE et al. Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation. J Am Coll Cardiol 2004; 44:1071–1079.PubMedCrossRefGoogle Scholar
  3. 3.
    Gerstenfeld EP, Callans DJ, Dixit S et al. Mechanism of organized left atrial tachycardias occurring after pulmonary vein isolation. Circulation 2004; 110:1351–1357.PubMedCrossRefGoogle Scholar
  4. 4.
    Jaïs P, Hocini M, Hsu LF et al. Technique and results of linear ablation at the mitral isthmus. Circulation 2004; 110:2996–3002.PubMedCrossRefGoogle Scholar
  5. 5.
    Kobza R, Hindricks G, Tanner H et al. Late recurrent arrhythmias after ablation of atrial fibrillation: incidence, mechanism, and treatment. Heart Rhythm 2004; 1: 676–683PubMedCrossRefGoogle Scholar
  6. 6.
    Cummings JE, Schweikert R, Saliba W et al. Left atrial flutter following pulmonary vein antrum isolation with radiofrequency energy: linear lesions or repeat isolation. J Cardiovasc Electrocphysiol 2005; 16: 293–297.CrossRefGoogle Scholar
  7. 7.
    Chugh A, Oral H, Lemola K et al. Prevalence, mechanism, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation. Heart Rhythm 2005; 2:464–471.PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia 2008

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