Iatrogenic postatrial fibrillation ablation left atrial tachycardia/flutter: how to prevent and treat it?

摘要

Atrial fibrillation is a common arrhythmia associated with significant morbidity and mortality; Prevention of recurrences with antiarrhythmic drugs is usually poorly effective over the long term; in addition it carries the risk of serious side effects including proarrhythmja. This has stimulated the development of new more effective and really curative treatments. Among these, radiofrequency catheter ablation of atrial fibrillation has gained a growing popularity in the last few years.Since the first report in 1994, several different techniques of ablation of atrial fibrillation have been proposed. They include replication of the surgical MAZE, elimination of pulmonary vein foci, segmental ostial pulmonary vein ablation, circumferential pulmonary vein ablation, pulmonary vein antrum isolation guided by intracardiac echocardiography,circular ablation plus linear lesions in the left atrium, complex fractionated atrial electrograms ablation, and double Lasso technique. All these techniques are aimed at suppressing or isolating the atrial fibrillation triggers arising from within the pulmonary veins and/or at modifying or eliminating the left atrial substrate responsible for the initiation and maintenance of the arrhythmia (including mother rotors and vagal nerve fibers).