The majority of studies evaluating recurrent AT after index AF ablation tend to target these additional inducible ATs for ablation and use non-inducibility as a procedural endpoint ( 5– 11). An important issue with repeat ablation for recurrent AT is that of further inducible ATs after the ablation of clinical AT. Given the often-continuous nature of arrhythmia, catheter ablation is the treatment of choice and is facilitated by high-density mapping systems. These tachycardias tend to be incessant, poorly tolerated, and unresponsive to pharmacological agents ( 3, 4). Advances in catheter and mapping technology over the last decade have been reflected in greater numbers referred for ablation, and a related consequence is the increased incidence of atrial tachycardia (AT) post-index procedure, which varies from 5 to 40% in the literature ( 2). Catheter ablation is a cornerstone therapy and carries a class I indication for the management of symptomatic drug-resistant, paroxysmal, and persistent AF ( 1). Large-scale, randomized trials are needed, nonetheless, to fully assess the optimal ablation strategy in the setting of recurrent AT post-AF ablation.Ītrial fibrillation (AF) represents the most common cardiac arrhythmia worldwide. Durable linear block, particularly at the mitral isthmus, is difficult to achieve but may be facilitated by the real-time evaluation of lesion quality and contiguity and the novel technique of vein of Marshall ethanol infusion. Nevertheless, once ablation of the clinical AT has been successfully performed, ensuring durable linear block and PV isolation may be sufficient for the prevention of further AT. A recent randomized study addressing the question of non-inducibility as a procedural endpoint demonstrated no additional benefits to the ablation of all induced, non-clinical ATs, but it was limited by small numbers and high rates of non-inducibility. Although multiple inducible ATs after ablation of the clinical AT are commonly described at repeat procedures, the optimal ablation strategy, and procedural endpoints are unclear in this setting. Recurrent atrial tachycardia (AT) is a common phenomenon after catheter ablation for AF, particularly in the setting of additional substrate ablation, with many studies demonstrating gap-related macro re-entrant AT (predominantly mitral and roof dependent) to be the dominant mechanism. Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium.Louisa O’Neill * Benjamin De Becker Maarten De Smet Jean-Benoit Le Polain De Waroux Rene Tavernier Mattias Duytschaever Sebastien Knecht
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