Incessant Ectopic Atrial Tachycardia Research Articles

Incessant Ectopic Atrial Tachycardia Accompanied by Unusual Neurological Manifestations – Case Report and Literature Review

Incessant ectopic atrial tachycardia (EAT) is well-known in the electrophysiology world. However, once accompanied by neurological manifestations, hence is a dilemma. We are reporting a 26-year-old male presenting with incessant symptomatic EAT. Once cardioverted, he began to manifest cardiovascular stroke clinical symptoms. Further objective investigation revealed no evidence of cardioembolic stroke. Our aim of this case report is to explore if there is a true correlation between EAT and possible neurological association and open further guidelines related to research.

Predictors of Pharmacological Therapy of Ectopic Atrial Tachycardia in Children.

Ectopic atrial tachycardia (EAT) is a relatively common type of supraventricular tachycardia in the pediatric population, and it can be resistant to antiarrhythmic drugs and lead to tachycardia-induced cardiomyopathy (TIC) if not properly managed. The purpose of this study was to determine the predictors of the response to pharmacological therapy in children with EAT. From January 2009 to April 2014, 115 children were admitted to our hospital with a diagnosis of EAT and placed on antiarrhythmic drugs. We examined the clinical history, response to therapy, and follow-up of the children. The incidence of TIC secondary to EAT was 22.6% (n=26) in children. Incessant EAT accounted for 44.3% of all patients. Control of EAT with antiarrhythmic therapy was achieved in 73.9% (n=85) of the children. The combination of sotalol and propafenone performed well in controlling EAT in children [complete control in 35 (49.3%) of 71]. The mean time of conversion to sinus rhythm was 24days, and the mean duration of therapy was 11months in children with resolution. Multivariate predictors of the control of EAT were age at presentation (OR 0.289, P=0.038) and tachycardia type (OR 0.276, P=0.006). TIC occurs in 22.6% of children with EAT. Incessant EAT is more frequently complicated by TIC. Independent factors associated with a good response to pharmacological therapy include a younger age at presentation and non-incessant tachycardia in children with EAT.

Clinical course and treatment of ectopic atrial tachycardia in 144 children

Ectopic atrial tachycardia (EAT) is a common type of supraventricular tachycardia in pediatric population, and it can be resistant to antiarrhythmic drugs and lead to tachycardia induced cardiomyopathy (TIC) if not properly managed. This study assessed the clinical course and response to treatment of EAT in children. A retrospective review included 144 children at the First Hospital of Tsinghua University diagnosed with EAT from January 2009 to April 2014. The clinical detailed history, 12 lead ECG, 24-h Holter recording, echocardiography, response to therapy and follow-up were analyzed. The onset of EAT occurred at any age with a distribution with positive skewness, 57 children ≤1 years, 22 children > 1 - 3 years, 25 children > 3 - 6 years and 40 children ≥ 6 years of age. The percentages of the three tachycardia types were 36. 1% (n = 52) for incessant EAT, 52. 8% (n = 76) for paroxysmal EAT and 11. 1% (n = 16) for sporadic EAT, respectively. There were 115 patients received drug therapy in our hospital and in 72 cases the EAT was completely controlled. Antiarrhythmic therapy had been discontinued in 35 children with complete control. Normal sinus rhythm was observed by telemetry or Holter within 4 to 90 days and the mean duration of medical therapy was 310 days (range 15 to 608 days) in these children. The combination of sotalol and propafenone showed better effectiveness for control of children with EAT (54%, 41/76), compared with single sotalol (36%, 24/66) and the combination of amiodarone and metoprolol (30%, 7/23) (χ2 = 6. 296, P = 0. 043). Tachycardia type was able to predict the response to antiarrhythmic drugs for children with EAT, sporadic tachycardia had best control rate on pharmacological therapy compared with paroxysmal tachycardia and incessant tachycardia (94% (15/16) vs. 67% (42/63) vs. 42% (15/36), χ2 = 17. 925, P = 0. 000) . Acute success of radiofrequency ablation (RFA) in children who showed poor response to antiarrhythmic drugs was achieved in 45 of 49 (92%), ultimate success was achieved in 33 of 49 (67%). The incidence of TIC secondary to EAT was 18. 1% (n =26), and left ventricular ejection-fraction (LVEF) returned to normal in 23 children after successful control of EAT ((61 ± 4) % vs. (43 ± 5) %, t = - 10. 036, P = 0. 000). Side effects including abnormal thyroid function (in 3) and abnormal liver function (in 1) occurred in 4 (17%) of 23 children who received amiodarone and disappeared when amiodarone was discontinued. EAT in children predominantly occurred in young infants and children. Incessant EAT comprised a great percentage. The combination of sotalol and propafenone provided the best results for control of children with EAT. RFA should be considered as a preferred treatment for older children who displayed poor response to medical therapy.

Dynamic behavior and autonomic regulation of ectopic atrial pacemakers.

Heart rate (HR) variability reflects the neural regulation of normal pacemaker tissue, but the autonomic nervous regulation of abnormal atrial foci originating outside the sinus node has not been well characterized. We compared the HR variability of tachycardias originating from the ectopic foci and the sinus node. R-R-interval variability was analyzed from 24-hour Holter recordings in 12 patients with incessant ectopic atrial tachycardia (average HR 107+/-14 bpm), 12 subjects with sinus tachycardia (average HR 106+/-9 bpm), and 24 age- and sex-matched subjects with normal sinus rhythm (average HR 72+/-8 bpm). Time- and frequency-domain HR variability measures, along with approximate entropy, short- and long-term correlation properties of R-R intervals (exponents alpha(1) and alpha(2)), and power-law scaling (exponent beta), were analyzed. Time- and frequency-domain measures of HR variability did not differ between subjects with ectopic and sinus tachycardia. Fractal scaling exponents and approximate entropy were similar in sinus tachycardia and normal sinus rhythm, but the short-term scaling exponent alpha(1) was significantly lower in ectopic atrial tachycardia (0.71+/-0.16) than in sinus tachycardia (1.16+/-0.13; P<0.001) or normal sinus rhythm (1.19+/-0.11; P<0.001). Abrupt prolongations in R-R intervals due to exit blocks from the ectopic foci or instability in beat-to-beat R-R dynamics were the major reasons for altered short-term HR behavior during ectopic tachycardias. HR variability obtained by time- and frequency-domain methods does not differ between ectopic and sinus tachycardias, which suggests that abnormal atrial foci are under similar long-term autonomic regulation as normal pacemaker tissue. Short-term R-R-interval dynamics are altered toward more random behavior in ectopic tachycardia, which may result from a specific autonomic disturbance or an intrinsic abnormality of ectopic atrial pacemakers.

Successful radiofrequency catheter ablation of automatic atrial tachycardia with regression of the cardiomyopathy picture.

Ectopic atrial tachycardia (EAT) is often refractory to pharmacological suppression, and if uncontrolled, it can lead to cardiomyopathy. Although RF current catheter ablation therapy has been effective in eliminating the arrhythmia, there is limited information, particularly in adult patients with regard to the reversal of the tachycardia induced cardiomyopathy. Four adult patients, 20-56 years of age, and a 6-year-old boy, were referred with refractory EAT. Four patients had heart failure and three had depressed LV function by echocardiographic criteria. All patients underwent electrophysiological study, and RF ablation was successful in abolishing the arrhythmogenic foci. Of these, four were located in the right atrium and one in the left atrium, and were identified by recording of the earliest atrial activation. No complications occurred. Termination of the EAT resulted in symptomatic improvement. Serial echocardiographic assessment of LV function indicated a significant reversal of the cardiomyopathy picture with reduction in chamber size and recovery in systolic function; indices of diastolic dysfunction persisted in one patient. Chronic, uncontrolled EAT can cause tachycardia induced cardiomyopathy. The picture of the cardiomyopathy resolves after elimination of the focus. RF ablation is both effective and safe, and may be considered as early therapy, particularly in patients with incessant EAT and ventricular dysfunction.

Incessant Ectopic Atrial Tachycardia and Sudden Death

A patient with refractory and incessant ectopic atrial tachycardia (IEAT) is reported in whom it was possible to document, during ECG (Holter) the occurrence of aborted sudden death by spontaneous ventricular fibrillation (VF). Following the second of two attempts at surgical ablation of the origin of the IEAT, the patient has been asymptomatic without antiarrhythmic drugs and in sustained sinus rhythm for 24 months. Although we cannot exclude the residual action of amiodarone and flecainide (proarrhythmia) or the residual peripartum cardiomyopathy it is probable that the observed VF was a true complication of a cardiomyopathy induced by a chronically increased heart rate (HR). Although unclear, this VF might be considered as a form of adrenergic-dependent long QT syndrome due to early afterdepolarization in the presence of predisposing myocardial conditions.

Time course of improvement in ventricular function after ablation of incessant automatic atrial tachycardia

A patient with dilated cardiomyopathy and supraventricular tachycardia presumed to be of sinus origin was referred for cardiac transplantation. The extreme rate of the tachycardia during exercise, profound fluctuations in heart rate, and the presence of an abnormal P wave axis suggested the diagnosis of incessant ectopic atrial tachycardia rather than compensatory sinus tachycardia. Electrophysiologic study with endocardial activation sequence mapping confirmed the diagnosis of an ectopic left atrial automatic tachycardia, after which surgical cryoablation of the left atrial focus was carried out successfully and sinus rhythm was restored. Serial radionuclide angiocardiograms obtained before and after surgery demonstrated a very rapid recovery of left ventricular function to nearly normal within the first month after surgery, followed by further improvement to normal over the next several months. The diagnosis of tachycardia-related cardiomyopathy should be seriously considered in any patient with apparently end-stage dilated cardiomyopathy and persistent resting tachycardia.

Diagnosis and surgical treatment of ectopic atrial tachycardia

Eighty-two patients with ectopic atrial tachycardia (EAT) were subjected to radical closed heart surgery (without cardiopulmonary bypass). The age of the patients ranged from 1 to 51 years. Permanent EAT was present in 19 patients, incessant EAT in 14, and paroxysmal EAT in 49 patients. Preoperative electrophysiological study included computed analysis of the P wave vector. Ectopic foci were established in the right atrium in 34 patients, in the left atrium in 11, in the interatrial septum in 32, and extracardially in 5 patients. For ablation or isolation of the foci, the cryogenic technique was used in 74 patients, cryo- and laser techniques in 4, and the laser technique alone in 1 patient. In 3 patients resection of the atrial auricles including the ectopic focus was undertaken. In 4 patients complete AV block was induced and a cardiac pacemaker implanted. After primary surgery, favourable results were obtained in 71 patients. In 11 patients recurrences were observed; 8 of these patients underwent successful repeat surgery. In 3 patients medical treatment was effective. Finally, the follow-up results have been promising-79 patients (96.4%) (including 4 patients in whom a complete AV block was created) have become arrhythmia-free. When EAT is resistant to medical treatment, closed heart ablation of the ectopic focus has proved to be safe (no mortality or morbidity) and effective. It can therefore be recommended not only for the termination of EAT but also for the prevention of dilated cardiomyopathy.

Evidence of abnormal automaticity and triggering activity in incessant ectopic atrial tachycardia

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Incessant ectopic atrial tachycardia: successful surgical treatment with regression of dilated cardiomyopathy picture

Ectopic atrial tachycardia is an unusual arrhythmia that usually occurs at a young age. t-3 It may be paroxysmal 2,~ or incessant, l-u The atrial rate is often more than 200 beats/min, especially in children. Other typical findings are abnormal frontal P-wave morphologic characteristics 4 and resistance to conventional antiarrhythmic therapy. 3 The incessant form of ectopic atrial tachycardia is sometimes associated with signs and symptoms of cardiac failure,/, 3,4 mimicking dilated cardiomyopathy. In such cases, it has not been possible to determine whether the arrhythmia is the primary cardiac disorder or a consequence of a myocardial disease.ran When an area responsible for the initiation or maintenance of an arrhythmia can be accurately defined, one prerequisite for elective arrhythmia surgery is fulfilled. Although the origin of ectopic atrial tachycardia can be localized in that way, few reports have described successful cases of surgical elimination of ectopic atrial tachycardia. 4-6 We observed 2 young patients with incessant ectopic atrial tachycardia in whom surgical treatment eliminated both the arrhythmia and the dilated cardiomyopathy.