10-year single center experience of catheter ablation of focal atrial tachycardia.

Abstract

Focal atrial tachycardias (ATs) represent 5-15% of sustained supraventricular tachycardias (SVTs). Characteristic distribution of sites of origin and detailed electrophysiologic characterization of AT from specific sites of origin (SOO) have been described. Acute success and recurrence are less favorable than for other SVTs. In this series, we present our experience of focal AT ablation over a 10-year period. We undertook a retrospective review of an electronically maintained database of all patients undergoing AT ablation at our institution between January 2011 and December 2020. Demographic, procedural, and outcomes data were reviewed. A total of 293 distinct atrial tachycardias were treated during 279 procedures in 256 patients, including 207 first AT ablations. Acutely successful AT suppression was achieved in 91% of first-time ablations. Acute success was dependent on SOO of AT with lowest rates of acute suppression in the para-Hisian region and the crista terminalis (CT). The most common reason for failure to acutely suppress the AT was proximity to a critical structure (phrenic nerve, sinus node, and AV node). 8.9% of patients in this series presented with a tachycardia-mediated cardiomyopathy (TCM). 48% of TCM patients underwent an ablation attempt during an acute medical admission. Among the TCM group, median LV ejection fraction increased from 25% (range 10-50%) to 55% (range 35-65%) with successful treatment of AT. Five patients undergoing a repeat procedure had planned pericardial access for displacement of the phrenic nerve to permit ablation of the AT, which was successful in all cases. Among patients without a pre-existing diagnosis of AF, peri-procedural AF was not associated with a higher incidence of a subsequent diagnosis of AF (odds ratio 1.169, 95% CI 0.4058-3.475, p = 0.7628). Median duration of follow-up was 832days. By Kaplan-Meier estimate, recurrence-free survival was 78% (95% CI 67-88%). In this series, focal AT ablation is associated with good acute results and a low rate of complications, but outcomes remain less favorable than previously reported for other forms of SVT.