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Clinical Significance of Induced Atrial Tachyarrhythmias After Termination of Chronic, Persistent Atrial Fibrillation During Stepwise Approach .
고려대학교 암암병원¹ , 연세대학교 신촌 세브란스병원²
Yasutsugu Nagamoto¹, Jong-Il Choi¹, Jae Seok Park¹ , Jae Jin Kwak¹ , Seung Young Rho¹ ,Hyun Soo Lee ¹ , Seung Yong Shin ¹ , Hong Euy Lim¹ , Sang Won Park ¹ , Hui-Nam Pak² , Young-Hoon Kim¹
Background: Acute atrial fibrillation (AF) termination has been used as the endpoint of catheter ablation of long-lasting persistent AF (PeAF). Whether an inducibility testing of atrial tachycardias (ATs) or AF after achieving AF termination in these patients is necessary or has incremental benefit, is not clarified. Purposes: The aim of this study was to evaluate the impact of ablation of induced ATs after PeAF termination on the clinical outcome and the relationship of the induced ATs with clinically recurrent ATs during follow-up. Methods: In 158 long-lasting PeAF patients underwent catheter ablation (pulmonary vein isolation with ablation at the multiple atrial sites), inducibility was tested by rapid atrial pacing after AF termination. AF or ATs were noninducible in 100 patients (63.3%) and inducible AF in 28 (18%) or AT in 30 (19%). We analyzed 30 patients with induced ATs. ATs were defined as organized arrhythmia with stable cycle length lasting longer than 5 minutes. Results: During the mean follow-up period (33±18months), 15 patients (50%) were free from ATs or AF, ATs were recurrent arrhythmias in 8 patients (28%) whereas AF was recurred only in 2 patients (8%) and both ATs and AF were recurrent in 3 patients (10%). Among 11 patients with recurrent ATs, 7 patients underwent the repeated ablation, 6 (85.7%) of which revealed different mechanisms compared to those of induced ATs. Conclusions: PeAF patients with positive induced ATs after AF termination were more likely to have ATs as recurrent arrhythmias during follow-up, however, the mechanisms were poorly correlated with clinically documented ATs.


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