Catheter Ablation Of Atrial Tachycardia Research Articles

Catheter Ablation of Atrial Tachycardia Originating from the Tip of Right Atrial Appendage

Right atrial appendage tachycardia is not common and can be eliminated by catheter ablation with a high success rate and low recurrence rate. However, the structural properties of the atrial appendage, including blind‐ended structure, abundant trabeculations, and reduced wall thickness could make the procedure of catheter ablation difficult, especially if the focus is at the tip of atrial appendage. We describe a case of atrial tachycardia originating from the tip of the right atrial appendage that was eliminated by catheter ablation in spite of some difficulties in manipulation of the catheter and achieving adequate radiofrequency power.

Catheter Ablation of Atrial Tachycardia Following Atrial Fibrillation Ablation

Atrial tachycardias represent the second front of atrial fibrillation (AF) ablation. They are frequently encountered during the index ablation for patients with persistent AF and are common following ablation of persistent AF, occurring in half of all patients who have had AF successfully terminated. An atrial tachycardia is rightly seen as a failure of AF ablation, as these tachycardias are poorly tolerated by patients. This article describes a simple, practical approach to diagnosis and ablation of these atrial tachycardias.

Giant Left Atrial Thrombus Associated with Ablation for Atrial Tachycardia

We report a very rare case of giant left atrial thrombus (size: 7.2 x 4.5 mm(2)) associated with radiofrequency catheter ablation for atrial tachycardia in a 72-year-old man. After 4 weeks of anticoagulation with warfarin, a repeat echocardiogram demonstrated partial resolution of the thrombus (size: 4.5 x 2.6 mm(2)) without systemic embolization.

Diagnosis and ablation of atypical atrial tachycardia and flutter complicating atrial fibrillation ablation

Depending on the ablation strategy, up to 30% to 50% of patients will develop an atrial tachycardia after undergoing radiofrequency catheter ablation of atrial fibrillation. This review discusses the mechanisms, mapping techniques, and catheter ablation of atrial tachycardias that occur after radiofrequency ablation of atrial fibrillation.

Electroanatomical mapping and radiofrequency catheter ablation of atrial tachycardia originating from the donor heart after orthotopic heart transplantation in a child

A 15-year-old boy who had been given an orthotopic heart transplant 12 years earlier underwent radiofrequency ablation after 14 months of tachycardia. At the time of the procedure, the patient presented moderate signs of heart failure and tachycardia-induced cardiomyopathy. During electroanatomical mapping we identified a focal atrial tachycardia with origin in the donor right atrium and bi-directional atrio-atrial conduction. After successful focal ablation the patient had two alternating atrial activation patterns, representing the recipient and the donor heart sinus rhythm. Two months after the ablation heart failure symptoms were in regress, and the patient was still in sinus rhythm.

Catheter Ablation of Atrial Tachycardia Originating from the Tip of Right Atrial Appendage

Right atrial appendage tachycardia is not common and can be eliminated by catheter ablation with a high success rate and low recurrence rate. However, the structural properties of the atrial appendage, including blind-ended structure, abundant trabeculations, and reduced wall thickness could make the procedure of catheter ablation difficult, especially if the focus is at the tip of atrial appendage. We describe a case of atrial tachycardia originating from the tip of the right atrial appendage that was eliminated by catheter ablation in spite of some difficulties in manipulation of the catheter and achieving adequate radiofrequency power.

Ablation of atrial tachycardias after correction of complex congenital heart diseases: utility of intracardiac echocardiography

Our goal was to analyse the utility of intracardiac echocardiography (ICE) for navigation and ablation of atrial tachycardias (ATs) after surgical correction of congenital heart disease (CHD). Catheter ablation of ATs was performed in seven patients (one woman, mean age 21 +/- 6 years) after correction of complex CHD: d-transposition of the great arteries (Mustard procedure in two patients, Senning procedure in two patients) and univentricular circulation (total cavopulmonary connection in two patients, atriopulmonary connection in one patient). The ablation was guided by a combination of electroanatomical mapping (CARTO, Biosense-Webster) and ICE (Acuson, Siemens). Intracardiac echocardiography was used during mapping to identify relevant anatomical structures and monitor tissue contact and for guidance of atrial baffle puncture. Biatrial mapping was necessary in six of seven patients and atrial baffle puncture in three. The clinical AT was abolished in all patients. No complications were noted. During follow-up of 23 +/- 13 months, two patients (28%) had arrhythmia recurrence. One patient developed atrial fibrillation, and recurrent AT in the other patient was controlled by re-ablation. Despite complicated cardiac anatomy, catheter ablation of AT after complex CHD can be performed safely and with a high success rate. Intracardiac echocardiography facilitates mapping, identification of relevant cardiac structures, and could be used for safe guidance of transbaffle puncture.

Image integration system to guide catheter ablation of atrial tachycardia with a multi-key-isthmus reentrant in a patient with a repaired atrial septal defect: a case report

Image integration system to guide catheter ablation of atrial tachycardia with a multi-key-isthmus reentrant in a patient with a repaired atrial septal defect: a case report

Electrical Connections between Persistent Left Superior Vena Cava and Left Atrium during Catheter Ablation for Atrial Tachycardia

A 74‐year‐old man presented with palpitation and 12‐lead ECG exhibited atrial premature contraction (APC) at general check‐up. Holter ECG demonstrated narrow QRS tachycardia with a rate of 160/min and more than 31,000/day atrial premature beats. The P wave morphology of atrial premature beats showed negative in II, III, aVF and biphasic in V1. Venography was performed and disclosed persistent left superior vena cava (LSVC) draining into the right atrium via the markedly dilated coronary sinus (CS). Electrogram recordings from LSVC and CS were obtained with an electrode catheter via the left subclavian vein. At the level where a ventricular potential disappeared, the intra‐LSVC potentials began to show a discrete second sharp potential after local left atrial signals. Double potentials were obtained within the LSVC from the lower left atrium (LA) to the higher LA. A proximal‐to‐distal activation sequence of the second components was observed. The interval between the 1st and 2nd component ranged from 8 to 22 msec between the proximal LSVC and distal LSVC. The double potentials resulted in fusion at the lower part of the LSVC, indicating the presence of an electrical connection between the LSVC and lower LA.

Electrical Connections between Persistent Left Superior Vena Cava and Left Atrium during Catheter Ablation for Atrial Tachycardia

Electrical Connections between Persistent Left Superior Vena Cava and Left Atrium during Catheter Ablation for Atrial Tachycardia

Successful Catheter Ablation of Atrial Tachycardia Originating from the Non-coronary Aortic Sinus

We report a rare case of atrial tachycardia originating from the non-coronary aortic sinus. After failed radiofrequency (RF) energy applications at right His-bundle region, the complete elimination of atrial tachycardia was achieved with an RF energy application in the non-coronary aortic sinus. With the review of other papers, this report emphasizes the importance of mapping in the non-coronary aortic sinus in focal atrial tachycardia near the atrioventricular node or near the Hisbundle.

Radiofrequency catheter ablation for atrial tachycardia originating from the left atrial appendage

A 36-year-old woman presented with drug-refractory atrial tachycardia. During the tachycardia episodes, P waves were positive in leads II, III, aVF, and V1, while they were negative in leads I and aVL. It was hard to determine whether the origin was the left atrial appendage or left superior pulmonary vein on the surface electrocardiogram. Electrophysiologic evaluation revealed that the earliest endocardial activation occurred at the base of the left atrial appendage, preceding the onset of P waves by 38 ms. On initiation of the tachycardia, a warm-up phenomenon was observed. There was a fixed relation between the coupling interval of a single extrastimulus and the return cycle length during the tachycardia. These findings suggested that the mechanism of the tachycardia was automaticity. Application of radiofrequency energy at the left atrial appendage terminated the tachycardia and it was not inducible after ablation.

Radiofrequency ablation of atrial tachycardia in patients with repaired atrial septal defect

Objective To evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia (AT) in patients with repaired atrial septal defects (ASD). Methods In 76 consecutive patients with AT who underwent the electrophysiological study and radiofrequency catheter ablation (RFCA). 4 patients (one male and three female aged 35.5 ± 11.5 years) had AT-related myocardial scar or incision. Earliest activation combined with entrainment mapping was adopted to determine a critical isthmus. Results Re-entry related to the lateral atriotomy scar was inducible in 3 of 4 patients. With entrainment mapping, the PPI-TCL difference was <30 ms when pacing at the inferior margins of the right lateral atriotomy scar. Among them, 2 patients had successful linear ablation between scar area to inferior vena cava, and 1 patient between scar areas to tricuspid annulus. Re-entry involving an ASD patch was demonstrated in 1 of 4 patients. PPI-TCL differences <30 ms were found when entraining tachycardia at sites near the septal patch. But linear ablation failed in terminating AT. There was no complication during procedure. No recurrence of incision-related AT was found during follow-up except for the failed patient. Conclusion Under conventional electrophysiological mapping, adopting linear ablation from scar area to anatomic barrier, successful ablation also can be obtained in patients with IRAT related to myocardial scar or incision.

Atrial Unipolar Potential in Radiofrequency Catheter Ablation of Atrial Tachycardia

We conducted this study to verify the efficacy of atrial unipolar potentialfor for ablation of atrial tachycardia. The morphology of atrial unipolar potential at the successful and the best unsuccessful ablation sites was analyzed in 35 patients with atrial tachycardia (sino-atrial reentrant tachycardia (SART) 15, adenosine-sensitive atrial reentrant tachycardia near the His bundle (HAT) 10, and non-reentrant ectopic atrial tachycardia (EAT) 10). The usefulness of atrial unipolar potential was compared with the Ao-Po interval. The incidences of QS pattern at the successful and the best unsuccessful sites were (successful versus unsuccessful; P, respectively) 93 versus 55%; P = 0.20 in SART, 90 versus 0%; P = 0.0001 in HAT, and 90 versus 10%; P = 0.001 in EAT. The mean Ao-Po intervals at the successful and the best unsuccessful sites were 35 versus 30 ms; NS in SART, 48 versus 45 ms; NS in HAT, and 58 versus 50 ms; NS in EAT. A significantly higher incidence of transient success at QS pattern sites was observed in SART than in HAT or EAT (n = 2 +/- 0.8 versus 0.2 +/- 0.1 and 0.1 +/- 0.1, P = 0.0005), and each transient site and final success site in SART was distributed linearly. The sensitivity and specificity of QS patterns with regard to the determination of appropriate target sites were 0.91 and 0.45 in SART, 0.9 and 1.0 in HAT, and 0.88 and 0.88 in EAT, respectively. In ablation of HAT and EAT, the QS pattern is very useful and should be given high priority when determining the optimum target site. In SART, the ablation success was often achieved by multiple, linear RF delivery near perinodal tissue, and the QS pattern could be a candidate for the optimum target site.

第18回 臨床不整脈研究会 僧帽弁形成術後の心房頻拍に対するカテーテルアブレーション後に洞機能不全をきたしcilostazol内服により永久ペースメーカーを回避し得た1例

第18回 臨床不整脈研究会 僧帽弁形成術後の心房頻拍に対するカテーテルアブレーション後に洞機能不全をきたしcilostazol内服により永久ペースメーカーを回避し得た1例

The Superior Transseptal Surgical Approach to Mitral Valve Creates Slow Conduction

Atrial tachycardia is very frequent after mitral valve surgery using the superior transseptal approach. Sixteen patients operated on for mitral valve disease (superior transseptal approach = Group A, n = 9, and left atrial approach = Group B, n = 7) underwent radiofrequency catheter ablation of atrial tachycardia guided by electroanatomic mapping. Twenty-six consecutive patients without previous cardiac surgery with typical atrial flutter served as controls (Group C). Atrial tachycardia occurred earlier after the operation in Group A than in Group B (median 97 vs 2,159 days, P = 0.003). Typical atrial flutter was the most frequent circuit in all groups (Group A-7 patients, Group B-5 patients, Group C-26 patients). Three patients in Group A developed right atrial incisional tachycardia. Ten of 14 tachycardia circuits (typical atrial flutter, n = 7, incisional tachycardia, n = 3) in Group A depended on the corridor between the right atrial part of the atriotomy and the tricuspid annulus. Slow conduction during typical atrial flutter was detected in this corridor in Group A, but not in the corresponding region in Groups B and C (P < 0.001). The cycle length of typical atrial flutter was longer in Groups A and B than in Group C (mean 283 ms and 282 ms vs 233 ms, P = 0.003). Patients in Group B with typical atrial flutter had larger right atria than patients in Group A or Group C (mean 156 mL vs 96 mL and 113 mL, P = 0.033). The superior transseptal incision may predispose to atrial tachycardia by creating slow conduction between the atriotomy and the tricuspid annulus.

AB8-4: The mechanisms and radiofrequency catheter ablation of atrial tachycardia following surgery for atrial fibrillation

Surgery is highly effective in curing atrial fibrillation (AF), with a maintenance rate of sinus rhythm of approximately 90%. However, atrial tachycardia (AT) develops in some patients postoperatively and its mechanism has not been examined in detail. We studied the mechanism of the postoperative AT, and determined the feasibility of radiofrequency (RF) catheter ablation in treating it.

Transthoracic percutaneous access for electroanatomic mapping and catheter ablation of atrial tachycardia in patients with a lateral tunnel Fontan

The incidence of atrial tachycardia following Fontan surgery is high, but access to the pulmonary venous atrium, a frequent site of arrhythmia origin, is limited. The purpose of this study is to report our results with a novel transthoracic percutaneous technique that provides direct access to the pulmonary venous atrium for electrophysiologic procedures. Six transthoracic ablation procedures were performed in five patients (age 1.2-17 years, weight 9.2-68.4 kg) with a lateral tunnel Fontan. Under biplane fluoroscopy, a percutaneous needle was advanced at the selected intercostal space toward the pulmonary venous atrium. Once access was confirmed, a sheath was placed over a wire and a Navistar CARTO catheter advanced for mapping and ablation. Additional catheters were placed in the baffle and esophagus for pacing and reference. Atrial tachycardia was induced, electroanatomic mapping performed, and candidate areas tested with entrainment techniques. Radiofrequency ablation was performed and success defined as the inability to reinduce tachycardia using the initiating protocol. All tachycardias were ablated. Procedure time ranged from 3.7 to 4.9 hours, and fluoroscopy time ranged from 31 to 70 minutes. Hospital stay was 2 days. One patient had a pneumothorax and two had a hemothorax that was drained. Tachycardia recurred in one patient at 3 months. Ablation was repeated successfully. Four patients are free of tachycardia at follow-up ranging from 6 to 29 months. Follow-up is not available for one child. Transthoracic percutaneous access provided a direct route to the pulmonary venous atrium for successful mapping and radiofrequency ablation in Fontan patients.

Prospective trial of electroanatomically guided, irrigated catheter ablation of atrial tachycardia in patients with congenital heart disease

Ablation success rates reported for atrial tachycardia (AT) patients with congenital heart disease (CHD) is lower than the rates reported for other varieties of supraventricular tachycardia. Retrospective studies suggest these rates might be increased by the use of irrigated radiofrequency (RF) ablation. The purpose of this study was to determine whether irrigated RF ablation increases ablation success rates in patients with CHD and AT. Patients were studied in a prospective, randomized, nonblinded manner. The operator was limited to use of randomized therapy (standard or irrigated ablation) for the first 6 minutes of RF application to each targeted arrhythmia. Lesion characteristics were recorded, and acute ablation success was ascertained. Structured clinical follow-up was performed over a 6-month period. Forty-seven ATs were targeted in 26 patients; 72% of these ATs were ablated. Within the 6-minute randomization period, no difference in success rates of standard and irrigated catheters was noted. However, crossover from standard to irrigated ablation more likely was successful than vice versa (irrigated: 8 successes/8 attempts vs standard: 1 success/4 attempts, P = .018), and overall success was greater using irrigated catheters (66% vs 33%, P = .019). Mean delivered power was slightly higher in irrigated lesions (32.5 W vs 30.2 W, P = .025), and mean temperature was much lower (33.5 degrees C vs 59.3 degrees C, P < .001). A composite AT intensity score was significantly reduced compared with preablation values at 6-month follow-up of all patients. Ablation of ATs in patients with CHD results in symptomatic improvement over short-term follow-up. Irrigated ablation may result in higher acute success rates in these patients.

Successful catheter ablation of atrial tachycardia following radial procedure for chronic atrial fibrillation

Successful catheter ablation of atrial tachycardia following radial procedure for chronic atrial fibrillation