环肺静脉左心房线性消融术后复发的房性心律失常

目的研究心房颤动(房颤)患者环肺静脉左心房线性消融术后复发房性心律失常的机制。方法28例房颤患者接受环肺静脉左心房线性消融术,平均年龄(54±11)岁,其中阵发性房颤10例,持续性房颤18例。采用Carto电解剖标测系统及双Lasso标测导管技术,分别进行环左、右侧肺静脉线性消融;消融终点为肺静脉电位消失,左心房-肺静脉双向阻滞。复发患者再次消融术采用双Lasso导管指导在原环形消融线上标测“漏点”并消融封闭之,对不能终止心动过速者再行拖带标测、激动标测或结合Carto系统标测;对典型心房扑动(房扑)行右心房峡部线性消融。结果初次消融术后平均随访(245±65)d,18例无复发;8例复发房性心律失常包括5例典型房扑、2例其他房性心动过速、1例阵发性房颤;2例左上肺静脉电位未完全隔离者仍持续房颤。除外1例持续性房颤,另外9例接受了再次消融术,证实所有复发患者均有左心房-肺静脉传导恢复;8例射频消融成功并随访(192±92)d无复发。结论左心房-肺静脉传导恢复是环肺静脉左心房线性消融术后复发房性心律失常的重要因素;初次手术附加右心房峡部线性消融可能减少复发率。     

三维标测系统指引导管消融治疗心房颤动——单中心800例总结

目的评价三维标测系统(CARTO或EnSite-NavX)指引导管消融治疗心房颤动(房颤)的总体疗效和安全性。方法2004年9月至2006年12月期间入选800例房颤患者,男性482例,女性318例,平均年龄62.1±15.6(18～82)岁。其中阵发性房颤611例,持续性房颤189例,平均左心房内径38.4±9.2(30～60)mm。采用EnSite-NavX系统260例,CARTO系统540例。对于阵发性房颤采取环肺静脉前庭电隔离,对于持续性房颤采取环肺静脉前庭电隔离 心房碎裂电位消融 二尖瓣峡部消融。术后口服华法林及ⅠC类和Ⅲ类抗心律失常药物1～3个月,每月随访心电图、24小时动态心电图一次。对于术后1个月的房颤或房性心动过速(房速)复发进行再次标测和消融。结果795例完成手术。平均手术时间161±33(140～245)min,X线透视时间17±13(12～45)min。左肺静脉电隔离率为96.5%,右肺静脉电隔离率为98.6%。阵发性房颤术中发作98例,消融终止房颤90例。阵发性房颤术后2周内早期复发137例(22.5%),103例2周后不再发作,共57例接受再次消融(6例接受三次消融)。持续性房颤环肺静脉消融恢复窦性心律30例(16.1%),转变为房速/心房扑动(房扑)15例(8.1%)。心房碎裂电位消融恢复窦性心律20例(10.8%),转变为房速/房扑23例(12.4%)。持续性房颤术后早期复发78例(41.9%),14例随访中不再发作。65例再次消融(10例接受三次消融)。所有病例房颤消融术后房扑/房速104例(13.1%),68例随访中自愈,30例再次消融,23例消融成功。并发症:心脏压塞5例(0.6%,3例内科保守治疗成功,2例外科修补),肺静脉狭窄6例(0.7%),一过性脑缺血(TIA)1例,脑栓塞2例,肠系膜动脉栓塞1例。血胸1例,气胸1例。股动脉假性动脉瘤3例,股动静脉瘘1例。术后平均随访16.2±5.7(3～27)个月,阵发性房颤550例(90.3%)无房性快速性心律失常发作(9.4%再次消融,11.5%口服抗心律失常药物);持续性房颤159例(85.5%)无房性快速心律失常发作(34.9%再次消融,28.5%服用抗心律失常药物)。结论三维标测系统(CARTO或EnSite-NavX)指引导管消融治疗房颤疗效较高,安全性好。对于阵发房颤采用环肺静脉前庭电隔离术式即有良好效果;对于持续性房颤结合碎裂电位消融、二尖瓣峡部消融等方法,而且40%患者需要多次消融以提高成功率。     

心房颤动消融术后二尖瓣峡部房性心动过速的发生机制及消融治疗

目的探讨心房颤动(简称房颤)患者环肺静脉左房线性消融术后二尖瓣峡部房性心动过速(简称房速)的发生机制及其消融策略。方法122例房颤患者采用EnSite-NavX和环状电极行环肺静脉左房线性消融,术后32例复发房颤或房速,8例经EnSite-NavX激动标测及拖带标测证实存在二尖瓣峡部房速,在三维导航下于左下肺静脉口部下缘至二尖瓣环之间行线性消融,对不能成功阻断二尖瓣峡部传导者予以冠状静脉窦内消融。术中同时探查双侧肺静脉电位,如传导恢复予以再次隔离。结果8例中2例呈无休止性发作,6例为阵发性,可被程序刺激诱发。房速的周长217.5±20.6ms,其中顺钟向折返5例,逆钟向折返3例。二尖瓣峡部线性消融至完全性双向传导阻滞5例,3例心内膜途径失败者经冠状静脉窦内消融,其中1例获得成功。术后随访5.5±4.3个月,6例无房颤及房速发作,1例仍有阵发性房速发作。另1例术后房速呈无休止发作,予以胺碘酮及美托洛尔控制心室率治疗。结论环肺静脉线性消融术后发生的二尖瓣峡部房速与左房线性消融治疗房颤的致心律失常作用有关,其主要的机制是消融线相关的大折返性心动过速,阻断峡部传导可以治疗此类房速。     

心房颤动导管消融复发患者二次消融研究

目的心房颤动（房颤）导管消融治疗仍然存在一定的复发率,而其复发的特点目前仍然不清,本文对房颤消融复发患者二次消融的特点进行分析。方法共442例房颤消融治疗患者中,29例消融后复发的患者[男性19例,年龄（56±11）岁],本文患者复发时间〉6个月。对这些复发患者进行二次导管消融治疗。分析和对比初次与二次消融的电生理特点。结果29例房颤患者（20例为阵发性房颤,9例为持续性房颤）复发时间6—33（11．3±5．3）个月,所有患者初次消融后均服用3个月抗心律失常药。在复发的29例患者中,（1）3例初次消融术采用单纯靶肺静脉电隔离,二次消融发现1例出现非消融肺静脉触发灶,予以补充消融;另2例发现原靶肺静脉均有传导恢复,予以所有肺静脉经验性电隔离。（2）12例初次消融策略为所有肺静脉（48根）经验性电隔离,二次消融时发现所有患者存在不同程度的肺静脉传导恢复（36根）,8例再次所有肺静脉节段电隔离（其中1例发现上腔静脉起源予以针对性电隔离）;4例患者采用三维标测系统指导下同侧肺静脉环形电隔离。（3）12例患者初次消融策略为三维标测系统指导下同侧肺静脉环形电隔离,二次消融时重复进行环肺静脉电隔离。1例患者术中发现左心房局灶性房性心动过速（房速）并成功消融,2例患者术中出现左心房不典型心房扑动（房扑）成功消融。二次消融术后随访（15±10）个月,5例患者出现房颤复发（阵发性房颤1例,持续性房颤4例;成功率82．8％）,1例患者出现严重左肺静脉狭窄。结论对于房颤进行肺静脉消融电隔离治疗,其复发患者以肺静脉传导恢复为复发的主要原因。单纯进行靶肺静脉消融的部分患者,其他肺静脉的触发灶对于复发起着重要的作用。部分复发患者与非肺静脉起源的触发灶相关。复发的房颤患者,再次导管消融治疗可以达到较高的治疗成功率。     

合并代谢综合征的阵发性心房颤动患者射频导管消融复发机制和再次消融分析

目的：探讨合并代谢综合征的阵发性心房颤动（房颤）患者导管消融复发的机制,以及代谢综合征对再次消融成功率的影响。方法自2005年1月至2007年9月入选首都医科大学附属北京安贞医院因阵发性房颤初次导管消融的患者共522例,175例复发,复发患者中98例行再次消融（3例失访）,资料完整的95例入选本研究。将患者分为代谢综合征组和非代谢综合征组。根据三维激动标测,以及隔离肺静脉后房颤是否终止和诱发将复发机制分为肺静脉机制和肺静脉外机制。结果95例患者中代谢综合征53例（55．8%）。代谢综合征组复发心律失常包括房颤24例（45．3%）,心房扑动（房扑）或房性心动过速（房速）14例（26．4%）,房颤合并房扑或房速15例（28．3%）;非代谢综合征组复发心律失常包括房颤18例（42．9%）,房扑或房速17例（40．5%）,房颤合并房扑/房速7例（16．7%）,两组间差异无统计学意义（P=0．244）。肺静脉-左心房传导恢复在代谢综合征组为83．3%,在非代谢综合征组为88．7%,两组间差异无统计学意义。复发机制考虑存在肺静脉外因素代谢综合征组25例（47．2%）,非代谢综合征组为20例（47．6%）（P=0．965）。平均随访3-73（29．6±20．5）个月,共有33例（34．7%）复发。代谢综合征组与非代谢综合征复发率差异无统计学意义（34．0%对35．7%, P=0．955）。结论代谢综合征对阵发性房颤导管消融后复发机制和再次消融成功率无影响。     

CARTO标测下导管消融治疗房性心律失常的效果

目的：探讨三维电磁导管定位系统（CARTO）指导下3种常见房性心律失常（房性心动过速、心房扑动和心房颤动）导管消融临床的疗效及电生理特征。方法：2008年7月～2013年7月在我院行CARTO指导下导管消融治疗的166例房性心律失常患者的临床应用和电生理资料进行回顾性分析。结果：①166例房性心律失常患者,其中32例为房性心动过速,26例心房扑动,108例心房颤动（阵发性心房颤动78例、持续性房颤30例）;②消融及随访结果：共计162例即刻消融成功,4例失败（房速3例、房扑1例）,总成功率为97．6％;随访6—60个月,复发30例,其中房速、房扑各2例,均再次消融成功;心房颤动复发24例（阵发性心房颤动14例、持续性心房颤动10例）,再次消融后8例成功,二次房颤消融成功率为85％;均未出现心包填塞、心房食管瘘等严重并发症。结论：CARTO三维标测下导管消融治疗房性心动过速、心房扑动、心房颤动等房性心律失常是安全有效的。     

心房颤动导管消融术后新发左房房性心动过速和/或心房扑动的研究现状

心房颤动(简称房颤)导管消融术后新发的左房房性心动过速(简称房速)、心房扑动(简称房扑)可发生于几乎所有的房颤消融术式,电生理检查表明大部分的房速、房扑为大折返机制,另一些为局灶性房速。初次消融的消融线出现缝隙可能是出现大折返性房速、房扑的主要原因。对于这些新发的左房房速、房扑再次行消融术可取得较高的成功率。     

心房颤动递进式线性消融后的左心房扑动

目的旨在探讨心房颤动（房颤）递进式线性消融术中出现的房性心律失常的电生理特点及消融的结果。方法对80例房颤消融中出现规律的房性心律失常进行非接触激动顺序标测,判断电生理机制并指导消融。结果共146阵心动过速,4阵为左心房房性心动过速（房速）,周长为（225±49）ms,其余142阵为左心房扑动,左心房激动时间占心动过速周长的100％,周长为（205±37）ms,均与房颤“7”字消融线上的缝隙有关。根据缝隙的位置将心房扑动的折返环分为3类：Ⅰ类（n=68）,缝隙位于左心耳-左上肺静脉间的嵴部,Ⅱ类（n=50）,缝隙位于左心房顶部,Ⅲ类（n=24）,缝隙位于二尖瓣环峡部。其中130阵消融成功,其余16阵因消融反应欠佳后经药物或体外电转复为窦性心律。随访（16．2±6．7）个月,82．5％（66／80）的患者可维持窦性心律。结论房颤递进式线性消融术中出现的房性心律失常多为大折返机制,且与“7”字消融线上的缝隙有关,这些缝隙主要位于左心耳-左上肺静脉间的嵴部。非接触标测技术能快速准确地识别这些缝隙并指导消融。     

单纯碎裂电位指导心房颤动消融的初步临床观察

目的探讨碎裂电位指导心房颤动（房颤）射频导管消融的可行性。方法22例药物治疗无效有症状的房颤患者（阵发性16例,持续性6例）,在自发或诱发房颤时,用Carto构建左心房或左、右心房的三维模型并标测、消融碎裂电位,终点是消除标测到所有碎裂电位或转复窦性心律。结果碎裂电位消融后,13例（59％）转复为窦性心律（直接转复7例,先转为房性心动过速（房速）／心房扑动（房扑）然后转复6例）,9例消融未转复窦性心律患者行电复律或药物复律成功。6例复发（5例房速／房扑,1例阵发性房颤）再次消融,5例成功,随访3—18（10．9±4．8）个月,共有16例（73％）无快速房性心律失常事件,碎裂电位主要分布于左侧房间隔、肺静脉周围、左心房顶部。碎裂电位消融后房颤终止前房颤周期与碎裂电位消融前相比明显延长[（157±18）ms vs （211±32）ms,P〈0．05]。除一例发生心脏压塞且心包穿刺成功引流外,无消融术相关的并发症和后遗症。结论碎裂电位指导房颤导管射频消融安全有效可行。     

持续性心房颤动消融后复发类型对再次消融的影响

目的:本研究旨在评价持续性心房颤动初次导管消融术后,复发不同心律失常类型对再次消融预后的影响。方法:连续入选持续性和长时程持续性心房颤动因初次消融后,复发接受第二次导管消融术的患者173例。初次消融策略为双侧肺静脉电隔离以及左心房顶部线、二尖瓣峡部线、三尖瓣峡部线的双向传导阻滞。根据术前心电图和病史特征以及术中电生理检查结果分为四组:复发持续性心房颤动组(Group 1,n=40),复发阵发性心房颤动组(Group 2,n=33),复发折返性房性心动过速组(Group 3,n=86),复发局灶性房性心动过速组(Group 4,n=14)。术后3、6、12个月和以后每6个月随访1次,评价无抗心律失常药物应用的情况下窦性心律的维持率。结果:基线资料分析发现,与其他三组患者相比Group 1患者左心房明显较大。初次消融术后有73.6%的患者至少1条肺静脉恢复传导,二尖瓣峡部线、三尖瓣峡部线和左心房顶部线恢复传导比例为68.8%、39.3%和50.9%。术中电生理检查结果显示,Group 3患者中47.7%的患者为二尖瓣峡部相关心房扑动。平均随访(26.6±8.8)月,104例患者(60.1%)无心律失常发作。复发组与未复发组差异无统计学意义。四组患者在未服用抗心律失常药物的情况下,窦性心律维持率分别为35.0%、57.6%、69.8%、78.6%(P=0.001)。结论:持续性心房颤动初次消融术后,复发心律失常以大折返性房性心动过速为主,复发折返或局灶房性心动过速患者再次消融后窦性心律维持率高。     

递进式消融法治疗持续性心房颤动的初步体会

目的评价一种递进式消融法治疗持续性心房颤动（房颤）的疗效。方法34例持续性房颤患者,年龄（54．8±11．4）岁,病程（36．5±9．8）个月。按以下顺序进行递进式消融：环肺静脉前庭消融达肺静脉电学隔离,左心房顶部和二尖瓣环峡部线性消融,心房碎裂电位消融,针对房颤转变的心房扑动（房扑）／房性心动过速（房速）行Carto激动标测结合拖带技术以明确其机制,并力求通过消融终止。结果递进式消融法使88．2％患者房颤节律发生变化（直接终止或转变为房扑／房速）,61．8％直接通过消融恢复窦性心律。随访（12．6±6．2）个月,82．4％患者维持窦性心律（其中42．9％服用胺碘酮）。结论递进式消融是治疗持续性房颤的一种有效方案。     

慢传导带传导阻滞作为心房扑动消融终点的意义（附Halo导管应用一例报告）

应用Ｈａｌｏ导管标测技术，结合冠状静脉窦与希氏束电图识别心房扑动折返环的慢传导带，在下腔静脉口到三尖瓣环峡部作射频线性消融，并以慢传导带出现双向阻滞作为心房扑动消融成功的标志，治疗了１例Ｉ型心房扑动患者。随访１个月心动过速未发。由于Ｈａｌｏ导管能在右房内全面记录右房激动顺序，便于了解峡部的传导情况，在心房扑动消融中有助于明确其诱发与终止的机制，并为慢传导带传导阻滞作为成功消融终点提供了可靠的手段。     

Atrial tachycardia masquerading as atrial flutter following ablation of the subeustachian isthmus

We report a case of atrial tachycardia masquerading as atrial flutter in a man who had previously undergone catheter ablation for atrial flutter. The recurrent arrhythmia was electrocardiographically almost identical to the prior atrial flutter; at repeat electrophysiologic study, although bidirectional conduction block was observed in the tricuspid annulus-inferior vena caval isthmus, the atrial arrhythmia was readily initiated. Activation mapping suggested typical atrial flutter, but entrainment techniques demonstrated intra-atrial reentry not involving the ablated isthmus. This case illustrates the need to apply entrainment techniques even in cases of apparent "typical" atrial flutter to confirm that putative ablation targets are necessary for tachycardia perpetuation.     

Flutter localized to the anterior left atrium after catheter ablation of atrial fibrillation

INTRODUCTION: Organized atrial arrhythmias following atrial fibrillation (AF) ablation are typically due to recovered pulmonary vein (PV) conduction or reentry at incomplete ablation lines. We describe the role of nonablated anterior left atrium (LA) in arrhythmias observed after AF ablation. METHODS: A total of 275 consecutive patients with paroxysmal (n = 200) or chronic (n = 75) AF had PV isolation with/without additional linear ablation at the mitral isthmus (n = 106), LA roof (n = 23), or both (n = 88). Organized arrhythmias occurring after ablation were evaluated utilizing activation and entrainment mapping. RESULTS: Fourteen patients (11 female, 65 +/- 13 years, 10 chronic AF, 10 structural heart disease) demonstrated tachycardia localized to the anterior LA, an area not targeted by prior ablation. Eight had ECG features during sinus rhythm suggestive of impaired anterior LA conduction at baseline. These arrhythmias demonstrated a distinctive ECG flutter morphology in 7 of 10 (70%) with discrete -/+ or +/-/+ aspect in inferior leads. Mapping the anterior LA revealed electrograms spanning the entire tachycardia cycle length (325 +/- 125 msec). Entrainment was possible in all with a postpacing interval exceeding the tachycardia cycle length by 9 +/- 10 msec. Electroanatomic mapping in 6 demonstrated small reentrant circuits rotating clockwise in 4 and counterclockwise in 2. Low-amplitude, fractionated mid-diastolic potentials with long duration (200 +/- 80 msec) occupying 63 +/- 22% of the cycle length were targeted for ablation resulting in termination and subsequent noninducibility. CONCLUSION: Organized arrhythmias occurring after AF ablation can be due to reentrant circuits localized to the anterior LA, predominantly in females with chronic AF, structural heart disease, and abnormal atrial conduction. They are characterized by a distinctive surface ECG and highly responsive to RF ablation at the slow conduction area.     

Mapping and ablation of atrial arrhythmia after valve surgery plus mini-maze procedure

Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the surgery strategy.Methods Mini-maze procedure was defined as follow: Pulmonary vein encircling incision and roof line connecting the two circles lesion,left atrial isthmus lesion,and the right atrial isthmus lesion.There were 517 patients with rheumatic valvular disease and pre-operative atrial fibrillation (AF) undergoing valve surgery plus mini-maze procedure in our hospital in the last 3 years,and 93 patients(18%) had recurrent atrial arrhythmia.Twelve patients(6 males and 6 females,mean age 53.8±7.8 ys) underwent electrophysiological study using 3-D mapping system(10 pts) or conventional mapping method(2 pts).Results The first recurrent time from surgery was 4.4±2.2 months.The mean follow-up time after catheter ablation was(12.0±6.0) months.One patient with sinus bradycardia had recurrent incessant atrial tachycardia (AT),but the AT was terminated by catheter position and never could be induced any more.She underwent a repeat procedure but failed just as the course in the first time, and was treated with DDDR pacemaker plus amiodarone.Six patients had 10 kinds of stable AT,including 5 at right atrial isthmus,2 at roof line,1 related to right atrial incision, 1 at anterior wall of left atrial,and 1 related to left superior pulmonary vene.All the stable AT were eliminated and remained sinus rhythm.Three patients had ATs with variable cycle length and the 3-D mapping suggested macro-reentry AT around mitral annulus.We tried to ablate at routine mitral isthmus and also in coronary sinus,but could not reach bi-directional conduction blocking.The other 2 patients were AF with reconnection at all previous ablation sites.Ablation strategy for AF included lesion at re-conduction sites and complex fractionated atrial electrogram.The patients with AF and mitral isthmus related AT were administrated with     

Radiofrequenz-Katheterablation von Vorhofflattern und Vorhofflimmern

Radiofrequency catheter ablation is now considered as a curative approach in patients with typical atrial flutter. Typical atrial flutter is due to a macrore-entrant circuit within the right atrium and it can be eliminated by a linear lesion in the isthmus between the tricuspid annulus and the vena cava inferior. The electrophysiological criterion of a bidirectional isthmus block has been shown to reduce the recurrence rate of atrial flutter after catheter ablation, thus achieving long-term cure of typical atrial flutter. Acute success rates of 85 to 90% and recurrence rates of 10 to 15% have been reported. The risk of paroxysmal atrial fibrillation continues to be clinically relevant in patients who underwent successful ablation of atrial flutter, in particular in patients with previously documented atrial fibrillation. The incidence of a new onset of atrial fibrillation after ablation of atrial flutter seems to be approximately 20%. Isthmus ablation has also been shown to be beneficial for the majority of patients with typical atrial flutter and atrial fibrillation: In addition to an elimination of typical atrial flutter the isthmus ablation apparently reduces the incidence of paroxysmal atrial fibrillation. At present, atrial fibrillation can only be treated by catheter ablation as a curative approach in the rare cases where an accessory pathway, an AV nodal re-entrant tachycardia, typical atrial flutter or an ectopic atrial tachycardia is the induction mechanism of the atrial fibrillation. The majority of patients with atrial fibrillation is apparently not amenable to a curative local ablation. While AV junction ablation and AV node modification can palliate some of the symptoms of atrial fibrillation by a control of ventricular rate, the arrhythmia persists with the loss of AV synchrony and continued risk of thromboembolism. The surgical MAZE procedure implies a compartimentation of the atria by surgical incisions resulting in areas to small to sustain the arrhythmia. Based on this procedure experimental and clinical studies are currently performed in order to develop catheter ablation cure of atrial fibrillation.     

Electrophysiological Characteristics of Localized Reentrant Atrial Tachycardia Occurring After Catheter Ablation of Long-Lasting Persistent Atrial Fibrillation

Background: Mapping of recurrent atrial tachycardia (AT) after extensive ablation for long-lasting persistent atrial fibrillation (AF) is complex. We sought to describe the electrophysiological characteristics of localized reentry occurring after ablation of long-lasting persistent AF.
Methods: Out of 70 patients undergoing catheter ablation of long-lasting persistent AF, 9 patients (13%, 55 ± 8 years, 8 males) in whom localized reentry was demonstrated in a repeat ablation were studied. Localized reentry was defined as reentry in which the circuit was localized to a small area and did not have a central obstacle. The mechanism of AT was determined by electroanatomical and entrainment mapping.
Results: Nine localized reentries with cycle length of 243 ± 41 ms were mapped in 9 patients. The location of AT was the left atrial appendage in 4 patients, anterior left atrium in 2, left septum in 2, and mitral isthmus in 1. In all ATs, a critical isthmus of <10 mm in width was identified in the vicinity of the prior linear lesions or ostia of isolated pulmonary veins. Ablation of the critical isthmus, which was characterized by continuous low-voltage activity (median voltage: 0.15 mV, mean duration: 117 ± 31 ms), terminated AT and rendered it noninducible. Additionally, ablation was performed for all of inducible ATs. At 11 ± 7 months after the procedure, 8 of 9 patients (89%) were free from any arrhythmias.
Conclusions: After ablation of long-lasting persistent AF, localized reentry may arise from a site in the vicinity of the prior ablation lesions. Ablation of the critical isthmus eliminates the arrhythmia.     

Regular supraventricular tachycardias associated with idiopathic atrial fibrillation

The present study analyzed the recurrence rate of idiopathic atrial fibrillation (AF) after elimination by radiofrequency ablation of the substrate for a regular tachycardia. Forty consecutive patients with idiopathic AF and a history of regular palpitations or documented regular tachyarrhythmias were prospectively included. Regular tachyarrhythmias were induced in 82.5% of patients: atrial flutter (42.4% of the inducible arrhythmias), atrial tachycardia (24.2%), atrioventricular (AV) nodal reentry (18.2%), AV reentry through a concealed accessory pathway (9.1%), and AV nodal reentry associated with right atrial tachycardia (6.1%). Dual AV node physiology with single or dual AV node echoes was demonstrated in 6.1% of patients without inducible arrhythmias. During follow-up (92 +/- 11 months), AF recurred in 19.2% of patients after successful radiofrequency ablation and in 69.2% after unsuccessful or not performed procedures (p <0.05). Left atrial diameter did not change after successful ablation but increased significantly in the population without elimination of the substrate (initial diameter 37.5 +/- 2 mm, final diameter 46.4 +/- 3.2 mm; p <0.05). In conclusion, the systematic search for the substrate of regular tachyarrhythmias followed by their elimination by catheter ablation reduces the recurrence of idiopathic AF in patients with a history of regular palpitations or documented regular tachyarrhythmias.