Recurrent atrial tachyarrhythmias after left atrial linear ablation surrounding ipsilateral pulmonary veins

Objective To investigate the probable mechanism of recurrent atrial tachyarrhymias after left atrial linear ablation surrounding ipsilateral pulmonary veins(PVs). Methods Ten patients with paroxysmal atrial fibrillation(AF) and 18 patients with persistent AF underwent left atrial linear ablation surrounding ipsilateral PVs guided by Carto electroanatomic mapping system and double Lasso catheters technique. The end point of ablation was defined as absence of all PV spikes documented with the 2 Lasso catheters within the ipsilateral PVs at least 30 minutes after isolation and bidirectional conduction block between left atrial and PVs. For the patients with recurrent atrial tachyarrhymias, double Lasso technique was used to find the gap of the original circle lines in the repeat ablation. Activation mapping and entrainment mapping were performed with or without Carto system to identify the earliest activated area or reentrant circuit. Cavotricuspid isthmus was ablated for patients with documented commen-type atrial flutter(AFL). Results After a median of (245±65) days of follow-up, eighteen patients were free of AF with or without antiarrhythmic drugs. Two patients with persistent AF remaining PV spikes in left superior PV failured being translated to sinus rhythm by cardioversion.Eight patients with recurrent atrial tachyarrhymias, including5 typical AFL, two atrial tachycardia and 1 parox-ysmal AF, underwent repeat ablation. Recovered conduction between left atrium and PVs were documented inall of them. Except1 patient with atrial tachycardia related to both atria, all the other8 patients were cured bythe second procedure and free of atrial tachyarrhythmia after (192±92) days follow-up.Conclusion Recov-ered conduction between left atrium and PVs was an important factor for the recurrent atrial tachyarrhytmia afterleft atrial linear ablation and additional ablation lines on cavotricuspid isthmus in the initial procedure could re-duce the secondary atrial tachycardia.