Complications of Atrial Fibrillation Ablation

When Prevention Is Better Than Cure

Antonio Sorgente; Gian-Battista Chierchia; Carlo de Asmundis; Andrea Sarkozy; Lucio Capulzini; Pedro Brugada


Europace. 2011;13(11):1526-1532. 

In This Article

Left Atrial Tachyarrhythmias

Left atrial tachycardias or left atrial flutters are the most common 'electrophysiological' complications of AF catheter ablation. Occurring in up to 31% of patients undergoing this procedure,[64] these arrhythmias are often more symptomatic than AF itself because they are often associated with high regular ventricular response. Usually caused by triggered activity originating from the ostia of reconnected PVs or by macroreentry around large functional or anatomical barriers (such as mitral annulus or previously isolated PVs), these tachycardias are strictly connected with the type of AF ablation previously performed. Several studies have confirmed that PVI obtained with an anatomic approach (simple encircling of the PVs without confirmation of electrical isolation) is associated with a higher incidence of atrial tachyarrhythmias compared with a segmental approach (consisting in PVI guided only by circular mapping catheter).[65,66] A possible explanation of this finding is that substrate AF ablation is more often associated with electrical gaps and electrical gaps are often the primary cause of both triggered and/or reentrant tachycardias.[67] Clinical management of these arrhythmias should be, first of all, conservative (rate control or cardioversion are both suitable options), since about one-third breaks spontaneously. For tachycardia persisting long after ablation, a re-do procedure should be performed using one of the available 3D mapping systems.