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Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation

Atrial tachycardias (ATs) may be classified into three broad categories: focal ATs, macroreentry and localised reentry – also known as ‘microreentry’. Features that distinguish these AT mechanisms include electrogram characteristics, responses to entrainment and pharmacological sensitivities. Focal...

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Autores principales: Markowitz, Steven M, Thomas, George, Liu, Christopher F, Cheung, Jim W, Ip, James E, Lerman, Bruce B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Radcliffe Cardiology 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528065/
https://www.ncbi.nlm.nih.gov/pubmed/31114688
http://dx.doi.org/10.15420/aer.2019.17.2
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author Markowitz, Steven M
Thomas, George
Liu, Christopher F
Cheung, Jim W
Ip, James E
Lerman, Bruce B
author_facet Markowitz, Steven M
Thomas, George
Liu, Christopher F
Cheung, Jim W
Ip, James E
Lerman, Bruce B
author_sort Markowitz, Steven M
collection PubMed
description Atrial tachycardias (ATs) may be classified into three broad categories: focal ATs, macroreentry and localised reentry – also known as ‘microreentry’. Features that distinguish these AT mechanisms include electrogram characteristics, responses to entrainment and pharmacological sensitivities. Focal ATs may occur in structurally normal hearts but can also occur in patients with structural heart disease. These typically arise from preferential sites such as the valve annuli, crista terminalis and pulmonary veins. Macro-reentrant ATs occur in the setting of atrial fibrosis, often after prior catheter ablation or post atriotomy, but also de novo in patients with atrial myopathy. High-resolution mapping techniques have defined details of macro-reentrant circuits, including zones of conduction block, scar and slow conduction. Localised reentry occurs in the setting of diseased atrial myocardium that supports very slow conduction. A characteristic feature of localised reentry is highly fractionated, low-amplitude electrograms that encompass most of the tachycardia cycle length over a small diameter. Advances in understanding the mechanisms of ATs and their signature electrogram characteristics have improved the efficacy and efficiency of catheter ablation.
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spelling pubmed-65280652019-05-21 Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation Markowitz, Steven M Thomas, George Liu, Christopher F Cheung, Jim W Ip, James E Lerman, Bruce B Arrhythm Electrophysiol Rev Electrophysiology and Ablation Atrial tachycardias (ATs) may be classified into three broad categories: focal ATs, macroreentry and localised reentry – also known as ‘microreentry’. Features that distinguish these AT mechanisms include electrogram characteristics, responses to entrainment and pharmacological sensitivities. Focal ATs may occur in structurally normal hearts but can also occur in patients with structural heart disease. These typically arise from preferential sites such as the valve annuli, crista terminalis and pulmonary veins. Macro-reentrant ATs occur in the setting of atrial fibrosis, often after prior catheter ablation or post atriotomy, but also de novo in patients with atrial myopathy. High-resolution mapping techniques have defined details of macro-reentrant circuits, including zones of conduction block, scar and slow conduction. Localised reentry occurs in the setting of diseased atrial myocardium that supports very slow conduction. A characteristic feature of localised reentry is highly fractionated, low-amplitude electrograms that encompass most of the tachycardia cycle length over a small diameter. Advances in understanding the mechanisms of ATs and their signature electrogram characteristics have improved the efficacy and efficiency of catheter ablation. Radcliffe Cardiology 2019-05 /pmc/articles/PMC6528065/ /pubmed/31114688 http://dx.doi.org/10.15420/aer.2019.17.2 Text en Copyright © 2019, Radcliffe Cardiology https://creativecommons.org/licenses/by-nc/4.0/legalcode This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.
spellingShingle Electrophysiology and Ablation
Markowitz, Steven M
Thomas, George
Liu, Christopher F
Cheung, Jim W
Ip, James E
Lerman, Bruce B
Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation
title Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation
title_full Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation
title_fullStr Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation
title_full_unstemmed Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation
title_short Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation
title_sort atrial tachycardias and atypical atrial flutters: mechanisms and approaches to ablation
topic Electrophysiology and Ablation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528065/
https://www.ncbi.nlm.nih.gov/pubmed/31114688
http://dx.doi.org/10.15420/aer.2019.17.2
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