Incidence, electrophysiological characteristics, and long‐term follow‐up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block
Abstract Introduction After mitral isthmus (ΜΙ) catheter ablation, perimitral atrial flutter (PMF) circuits can be maintained due to the preservation of residual myocardial connections, even if conventional pacing criteria for complete MI block are apparently met (MI pseudo‐block). We aimed to study...
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| Format: | Article |
| Language: | English |
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Wiley
2021-06-01
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| Series: | Journal of Arrhythmia |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/joa3.12545 |
| _version_ | 1818443670798467072 |
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| author | Panagiotis Ioannidis Evangelia Christoforatou Theodoros Zografos Panagiotis Charalambopoulos Konstantinos Kouvelas Georgios Christoulas Periklis Syros Georgios Tsitsinakis Theodora Kappou Andreas Tsoumeleas Sotirios Floros Dimitrios Tagoulis Ioannis Ntarladimas Ioannis Tagoulis Dimitrios Avzotis Antonis S. Manolis Charalambos Vassilopoulos |
| author_facet | Panagiotis Ioannidis Evangelia Christoforatou Theodoros Zografos Panagiotis Charalambopoulos Konstantinos Kouvelas Georgios Christoulas Periklis Syros Georgios Tsitsinakis Theodora Kappou Andreas Tsoumeleas Sotirios Floros Dimitrios Tagoulis Ioannis Ntarladimas Ioannis Tagoulis Dimitrios Avzotis Antonis S. Manolis Charalambos Vassilopoulos |
| author_sort | Panagiotis Ioannidis |
| collection | DOAJ |
| description | Abstract Introduction After mitral isthmus (ΜΙ) catheter ablation, perimitral atrial flutter (PMF) circuits can be maintained due to the preservation of residual myocardial connections, even if conventional pacing criteria for complete MI block are apparently met (MI pseudo‐block). We aimed to study the incidence, the electrophysiological characteristics, and the long‐term outcome of these patients. Methods Seventy‐two consecutive patients (mean age 62.4 ± 10.2, 62.5% male) underwent MI ablation, either as part of an atrial fibrillation (AF) ablation strategy (n = 35), or to treat clinical reentrant atrial tachycardia (AT) (n = 32), or to treat AT that occurred during ablation for AF (n = 5). Ιn all patients, the electrophysiological characteristics of PMF circuits were studied by high‐density mapping. Results Mitral isthmus block was successfully achieved in 69/72 patients (95.6%). Five patients developed PMF after confirming MI block. In these patients, high‐density mapping during the PMF showed a breakthrough in MI with extremely low impulse conduction velocity (CV). In contrast, in usual PMF circuits that occurred after AF ablation, the lowest CV of the reentrant circuit was of significantly higher value (0.07 ± 0.02 m/s vs 0.25 ± 0.07 m/s, respectively; P < .001). Patients presented with clinical AT had better prognosis in maintaining sinus rhythm after MI ablation compared with patients presented with AF. Conclusion Perimitral atrial flutter with MI pseudo‐block may be present after MI ablation and has specific electrophysiological features characterized by remarkably slow CV in the MI. Thus, even after MI block is achieved, a more detailed mapping in the boundaries of the ablation line or reinduction attempts may be needed to exclude residual conduction. |
| first_indexed | 2024-12-14T19:03:44Z |
| format | Article |
| id | doaj.art-0f264454cfb341bc9bbe379c8c69acc4 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 1883-2148 |
| language | English |
| last_indexed | 2024-12-14T19:03:44Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-0f264454cfb341bc9bbe379c8c69acc42022-12-21T22:50:54ZengWileyJournal of Arrhythmia1880-42761883-21482021-06-0137358459610.1002/joa3.12545Incidence, electrophysiological characteristics, and long‐term follow‐up of perimitral atrial flutter in patients with previously confirmed mitral isthmus blockPanagiotis Ioannidis0Evangelia Christoforatou1Theodoros Zografos2Panagiotis Charalambopoulos3Konstantinos Kouvelas4Georgios Christoulas5Periklis Syros6Georgios Tsitsinakis7Theodora Kappou8Andreas Tsoumeleas9Sotirios Floros10Dimitrios Tagoulis11Ioannis Ntarladimas12Ioannis Tagoulis13Dimitrios Avzotis14Antonis S. Manolis15Charalambos Vassilopoulos16Heart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceFirst Cardiology Department Red Cross Hospital Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceFirst Department of Cardiology Athens University School of Medicine Athens GreeceHeart Rhythm Center Athens Bioclinic Athens GreeceAbstract Introduction After mitral isthmus (ΜΙ) catheter ablation, perimitral atrial flutter (PMF) circuits can be maintained due to the preservation of residual myocardial connections, even if conventional pacing criteria for complete MI block are apparently met (MI pseudo‐block). We aimed to study the incidence, the electrophysiological characteristics, and the long‐term outcome of these patients. Methods Seventy‐two consecutive patients (mean age 62.4 ± 10.2, 62.5% male) underwent MI ablation, either as part of an atrial fibrillation (AF) ablation strategy (n = 35), or to treat clinical reentrant atrial tachycardia (AT) (n = 32), or to treat AT that occurred during ablation for AF (n = 5). Ιn all patients, the electrophysiological characteristics of PMF circuits were studied by high‐density mapping. Results Mitral isthmus block was successfully achieved in 69/72 patients (95.6%). Five patients developed PMF after confirming MI block. In these patients, high‐density mapping during the PMF showed a breakthrough in MI with extremely low impulse conduction velocity (CV). In contrast, in usual PMF circuits that occurred after AF ablation, the lowest CV of the reentrant circuit was of significantly higher value (0.07 ± 0.02 m/s vs 0.25 ± 0.07 m/s, respectively; P < .001). Patients presented with clinical AT had better prognosis in maintaining sinus rhythm after MI ablation compared with patients presented with AF. Conclusion Perimitral atrial flutter with MI pseudo‐block may be present after MI ablation and has specific electrophysiological features characterized by remarkably slow CV in the MI. Thus, even after MI block is achieved, a more detailed mapping in the boundaries of the ablation line or reinduction attempts may be needed to exclude residual conduction.https://doi.org/10.1002/joa3.12545atrial fibrillationatrial tachycardiascatheter ablationlinear lesionsmitral isthmusperimitral atrial flutter |
| spellingShingle | Panagiotis Ioannidis Evangelia Christoforatou Theodoros Zografos Panagiotis Charalambopoulos Konstantinos Kouvelas Georgios Christoulas Periklis Syros Georgios Tsitsinakis Theodora Kappou Andreas Tsoumeleas Sotirios Floros Dimitrios Tagoulis Ioannis Ntarladimas Ioannis Tagoulis Dimitrios Avzotis Antonis S. Manolis Charalambos Vassilopoulos Incidence, electrophysiological characteristics, and long‐term follow‐up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block Journal of Arrhythmia atrial fibrillation atrial tachycardias catheter ablation linear lesions mitral isthmus perimitral atrial flutter |
| title | Incidence, electrophysiological characteristics, and long‐term follow‐up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block |
| title_full | Incidence, electrophysiological characteristics, and long‐term follow‐up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block |
| title_fullStr | Incidence, electrophysiological characteristics, and long‐term follow‐up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block |
| title_full_unstemmed | Incidence, electrophysiological characteristics, and long‐term follow‐up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block |
| title_short | Incidence, electrophysiological characteristics, and long‐term follow‐up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block |
| title_sort | incidence electrophysiological characteristics and long term follow up of perimitral atrial flutter in patients with previously confirmed mitral isthmus block |
| topic | atrial fibrillation atrial tachycardias catheter ablation linear lesions mitral isthmus perimitral atrial flutter |
| url | https://doi.org/10.1002/joa3.12545 |
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