Electrophysiologic and electrocardiographic characteristics of focal atrial tachycardia arising from superior tricuspid annulus

Abstract

This study describes the electrophysiologic and electrocardiographic characteristics of focal atrial tachycardia (AT) arising from superior tricuspid annulus in six (1.9%) patients of a consecutive series of 320 patients. Six patients (mean age 42 +/- 22 years) with a mean cycle length of 326 ms of a consecutive series of 320 patients undergoing radiofrequency ablation for focal AT were mapped. During electrophysiologic study, tachycardia could be induced in five patients with programmed atrial extrastimuli while a spontaneous onset and offset with 'warm-up and cool-down' phenomenon was seen in the other patient. During tachycardia, P-wave morphology in Lead I, II, III and aVF was upright in all the six patients. The precordial leads were dominantly negative or isoelectric in V(1)-V(2) and positive in V(5)-V(6) with a transition at V(3) or V(4). Moreover, the tachycardia was sensitive to intravenous administration of adenosine triphosphate in five of six patients. Radiofrequency ablation was performed successfully in all patients (mean 4.5 +/- 1.2 applications). No recurrence of AT was observed after a mean follow-up of 8 +/- 6 months. Thus, AT arising from superior tricuspid annulus is rare. Radiofrequency ablation of this kind of AT is safe and effective.