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Characteristics and Outcomes of Atrial Tachycardia Originating from the Sinus Venosus during Catheter Ablation of Atrial Fibrillation.

Park YM, Kook H, Kim W, Lee SK, Choi JI, Lim HE, Park SW, Kim YH - Korean Circ J (2013)

Bottom Line: The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis.Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80±37 ms during AT.Using 4.4±2.7 radiofrequency focal applications, ATs were terminated and became no longer inducible in all.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

Background and objectives: The sinus venosus (SV) is not a well known source of atrial tachycardia (AT), but it can harbor AT during catheter ablation of atrial fibrillation (AF).

Subjects and methods: A total of 1223 patients who underwent catheter ablation for AF were reviewed. Electrophysiological and electrocardiographic characteristics and outcomes after catheter ablation of AT originating from the SV were investigated.

Results: Ten patients (0.82%) demonstrated AT from the SV (7 males, 53.9±16.0 years, 6 persistent) during ablation of AF. The mean cycle length was 281±73 ms. After pulmonary vein isolation and left atrial ablation, AF converted to AT from the SV during right atrial ablation in 2 patients, by rapid atrial pacing after AF termination in 7 patients, and during isoproterenol infusion in 1 patient. Positive P-waves in inferior leads were shown in most patients (90%). The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80±37 ms during AT. Using 4.4±2.7 radiofrequency focal applications, ATs were terminated and became no longer inducible in all. After ablation procedure, two patients showed transient right phrenic nerve palsy. After 19.9±14.8 months, all but 1 patient were free of atrial tachyarrhythmia without complications.

Conclusion: The AT which develops during AF ablation is rarely originated from SV, and its electrophysiologic characteristics may be helpful in guiding effective focal ablation.

No MeSH data available.


Related in: MedlinePlus

Double potentials were recorded during sinus (A), and a second discrete potential (*) preceded the onset of P wave during atrial tachycardia by mean of 80±37 ms (B). ABL: ablation catheter, HRA: high right atrium, CS: coronary sinus, AT: atrial tachycardia.
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Figure 2: Double potentials were recorded during sinus (A), and a second discrete potential (*) preceded the onset of P wave during atrial tachycardia by mean of 80±37 ms (B). ABL: ablation catheter, HRA: high right atrium, CS: coronary sinus, AT: atrial tachycardia.

Mentions: Electrophysiologic characteristics in each patient are summarized in Table 2. AT was sustained in 9 and non-sustained in 1 patient. The mean cycle length was 281±73 ms. After PV isolation and LA ablation, patients No. 2 and 3 spontaneously developed AT from SV during RA ablation; patients No. 1, 4, 5, 7, 8, 9 and 10 developed AT by rapid atrial pacing; and patient No. 6 showed AT during isoproterenol infusion. The activation sequence of AT was from proximal to distal in SVC and high to low at RA in all patients (Fig. 1). The activation sequence of CS was proximal to distal in all, except three patients who received linear peri-mitral ablation with a bidirectional block before developing AT from SV. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded 80±37 ms before the onset of P wave during AT (Figs. 1 and 2). Patient No. 4 revealed that the potential at SV to other areas was 2 : 1 conduction (Fig. 3). RA activation mapping using 3D was performed in patient No. 2 and 3. Both patients revealed that the earliest activation site was SV (Fig. 4). During atrial overdrive pacing at SV, the difference between post-pacing interval and tachycardia cycle length was less than 10 ms in all patients. Three patients received RF application at the crista terminalis (mean: 3.7±2.5; range: 1-6) for the target of AT before ablation at SV, and AT sustained. Patients No. 4, 5, 9, and 10 showed different morphology of AT originating from the RA septum, LA anterior wall, crista terminalis, and CS ostium, respectively, before developing AT from SV.


Characteristics and Outcomes of Atrial Tachycardia Originating from the Sinus Venosus during Catheter Ablation of Atrial Fibrillation.

Park YM, Kook H, Kim W, Lee SK, Choi JI, Lim HE, Park SW, Kim YH - Korean Circ J (2013)

Double potentials were recorded during sinus (A), and a second discrete potential (*) preceded the onset of P wave during atrial tachycardia by mean of 80±37 ms (B). ABL: ablation catheter, HRA: high right atrium, CS: coronary sinus, AT: atrial tachycardia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569564&req=5

Figure 2: Double potentials were recorded during sinus (A), and a second discrete potential (*) preceded the onset of P wave during atrial tachycardia by mean of 80±37 ms (B). ABL: ablation catheter, HRA: high right atrium, CS: coronary sinus, AT: atrial tachycardia.
Mentions: Electrophysiologic characteristics in each patient are summarized in Table 2. AT was sustained in 9 and non-sustained in 1 patient. The mean cycle length was 281±73 ms. After PV isolation and LA ablation, patients No. 2 and 3 spontaneously developed AT from SV during RA ablation; patients No. 1, 4, 5, 7, 8, 9 and 10 developed AT by rapid atrial pacing; and patient No. 6 showed AT during isoproterenol infusion. The activation sequence of AT was from proximal to distal in SVC and high to low at RA in all patients (Fig. 1). The activation sequence of CS was proximal to distal in all, except three patients who received linear peri-mitral ablation with a bidirectional block before developing AT from SV. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded 80±37 ms before the onset of P wave during AT (Figs. 1 and 2). Patient No. 4 revealed that the potential at SV to other areas was 2 : 1 conduction (Fig. 3). RA activation mapping using 3D was performed in patient No. 2 and 3. Both patients revealed that the earliest activation site was SV (Fig. 4). During atrial overdrive pacing at SV, the difference between post-pacing interval and tachycardia cycle length was less than 10 ms in all patients. Three patients received RF application at the crista terminalis (mean: 3.7±2.5; range: 1-6) for the target of AT before ablation at SV, and AT sustained. Patients No. 4, 5, 9, and 10 showed different morphology of AT originating from the RA septum, LA anterior wall, crista terminalis, and CS ostium, respectively, before developing AT from SV.

Bottom Line: The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis.Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80±37 ms during AT.Using 4.4±2.7 radiofrequency focal applications, ATs were terminated and became no longer inducible in all.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

Background and objectives: The sinus venosus (SV) is not a well known source of atrial tachycardia (AT), but it can harbor AT during catheter ablation of atrial fibrillation (AF).

Subjects and methods: A total of 1223 patients who underwent catheter ablation for AF were reviewed. Electrophysiological and electrocardiographic characteristics and outcomes after catheter ablation of AT originating from the SV were investigated.

Results: Ten patients (0.82%) demonstrated AT from the SV (7 males, 53.9±16.0 years, 6 persistent) during ablation of AF. The mean cycle length was 281±73 ms. After pulmonary vein isolation and left atrial ablation, AF converted to AT from the SV during right atrial ablation in 2 patients, by rapid atrial pacing after AF termination in 7 patients, and during isoproterenol infusion in 1 patient. Positive P-waves in inferior leads were shown in most patients (90%). The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80±37 ms during AT. Using 4.4±2.7 radiofrequency focal applications, ATs were terminated and became no longer inducible in all. After ablation procedure, two patients showed transient right phrenic nerve palsy. After 19.9±14.8 months, all but 1 patient were free of atrial tachyarrhythmia without complications.

Conclusion: The AT which develops during AF ablation is rarely originated from SV, and its electrophysiologic characteristics may be helpful in guiding effective focal ablation.

No MeSH data available.


Related in: MedlinePlus