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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

A representative example of fluoroscopic and three-dimensional images of the ablation site, SV (white arrow). Right-anterior oblique projection view 35° (A); left-anterior oblique projection view 35° (B); and three-dimensional images, white arrow and yellow dot indicates SV where AT terminated during RF application (C). ABL: ablation catheter, CS: coronary sinus, HRA: high right atrium, RF: radiofrequency, SV: sinus venosus, SVC: superior vena cava, AT: atrial tachycardia.
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Figure 6: A representative example of fluoroscopic and three-dimensional images of the ablation site, SV (white arrow). Right-anterior oblique projection view 35° (A); left-anterior oblique projection view 35° (B); and three-dimensional images, white arrow and yellow dot indicates SV where AT terminated during RF application (C). ABL: ablation catheter, CS: coronary sinus, HRA: high right atrium, RF: radiofrequency, SV: sinus venosus, SVC: superior vena cava, AT: atrial tachycardia.

Mentions: Using focal RF applications in those regions with mean frequency of 4.4±2.7, ATs were successfully terminated, as shown in Fig. 5. A representative example of the fluoroscopic and three-dimensional images of the ablation site is shown in Fig. 6. All the patients revealed that the precise location of ablation was the superior part of the SV. Focal RF ablation was successful in eliminating AT, and atrial tachyarrhythmias were no longer inducible in any patient.


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)

A representative example of fluoroscopic and three-dimensional images of the ablation site, SV (white arrow). Right-anterior oblique projection view 35° (A); left-anterior oblique projection view 35° (B); and three-dimensional images, white arrow and yellow dot indicates SV where AT terminated during RF application (C). ABL: ablation catheter, CS: coronary sinus, HRA: high right atrium, RF: radiofrequency, SV: sinus venosus, SVC: superior vena cava, AT: atrial tachycardia.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: A representative example of fluoroscopic and three-dimensional images of the ablation site, SV (white arrow). Right-anterior oblique projection view 35° (A); left-anterior oblique projection view 35° (B); and three-dimensional images, white arrow and yellow dot indicates SV where AT terminated during RF application (C). ABL: ablation catheter, CS: coronary sinus, HRA: high right atrium, RF: radiofrequency, SV: sinus venosus, SVC: superior vena cava, AT: atrial tachycardia.
Mentions: Using focal RF applications in those regions with mean frequency of 4.4±2.7, ATs were successfully terminated, as shown in Fig. 5. A representative example of the fluoroscopic and three-dimensional images of the ablation site is shown in Fig. 6. All the patients revealed that the precise location of ablation was the superior part of the SV. Focal RF ablation was successful in eliminating AT, and atrial tachyarrhythmias were no longer inducible in any patient.

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