valve surgery, low-voltage areas are often detected anterior

to the right
pulmonary veins (RPVs), corresponding to LA incisions.9
Left Atrial Macroreentry Postablation of Atrial
Fibrillation
LA MRAT is a frequent complication of surgical and
catheter-based
therapies of AF. The incidence and nature of ATs developing
post AF
ablation are, in large part, determined by the type of ablation
performed
and by the presence of abnormal LA substrate (see Chapter
15). The
incidence seems to be lower following segmental ostial
pulmonary vein
(PV) isolation than circumferential PV isolation and higher
following
circumferential or linear LA ablation (more than 30%). The
incidence
of MRAT is much higher (more than 50%) for approaches of
catheter
ablation incorporating extensive lesions in the LA to
terminate persistent
AF. Linear ablation lesions, together with anatomical
structures and
intrinsically abnormal adjacent atrial myocardium, provide
an ideal
substrate for reentry. Gaps in the ablation lines further
increase the
chance for reentry by creating a region of slow conduction
(see Fig. 13.1).
The most common form of macroreentry occurring after AF
ablation
is perimitral MRAT (accounting for approximately 40% of
all
MRATs). Macroreentrant circuits traversing the LA roof
account for
approximately 20% (see Fig. 15.60). Less common sites of
macroreentry
involve the right or left PVs, LA septum, and the base of the
LA appendage
(Fig. 13.3). Not infrequently, multiple macroreentrant
circuits and
multiple-loop reentrant circuits are encountered. In addition,
localized
reentrant circuits are not uncommon, and they usually arise
from the
vicinity of the isolated PVs or linear lesions.
LA MRATs comprise the majority of arrhythmias
developing following
surgical ablation of AF. Perimitral macroreentry is the most
common, but macroreentry circuits incorporating the LA
roof, septum,