Incessant Focal Atrial Tachycardia Research Articles

Catheter ablation for focal atrial tachycardias during pregnancy: A systematic review

ObjectivePregnancy can trigger maternal tachycardias, and the onset of recurrent or incessant focal atrial tachycardia (AT) can lead to tachycardia-induced cardiomyopathy. Medical interventions are commonly employed, but they carry potential fetal and maternal risks. Catheter ablation (CA), particularly with non-fluoroscopic navigation systems, may be considered as an alternative. This systematic review aims to explore the feasibility and outcomes of CA for focal AT during pregnancy. MethodsA thorough literature search was conducted until September 30th, 2023, on PubMed, Embase, and Cochrane databases. Included articles described maternal focal ATs diagnosed through electrophysiological studies and treated with CA. Data derived from these studies were organized into tables and subsequently analyzed. ResultsOut of 278 papers reviewed, 15 articles involving 24 patients were retrieved. CA, utilizing radiofrequency energy achieved acute success in 95.8% of cases. Sixteen patients (66.7%) underwent complete fluoroless procedures, with two adverse events directly related to the procedure reported. Long-term follow-up revealed minimal AT recurrences, with a 0.06% arrhythmia burden in one case. ConclusionFocal ATs during pregnancy can be incessant and refractory to medical intervention, precipitating an acute decline in left ventricular ejection fraction. In this setting, CA emerges as an efficacious treatment modality, particularly in cases of tachycardia-induced cardiomyopathies. Whenever feasible, it is advisable to perform these procedures with minimal or no fluoroscopy guidance. Larger studies are needed to establish the safety and the efficacy of CA for focal ATs during pregnancy, as current research consists of case reports or small case series.

Case report: Para Hisian Atrial Tachycardia

Case report: Para Hisian Atrial Tachycardia

Clinical characteristics and radiofrequency ablation of focal atrial tachycardia in 125 children

Objective: To investigate the clinical characteristics of focal atrial tachycardia (FAT) and the efficacy of radiofrequency catheter ablation (RFCA) in pediatric FAT. Methods: A total of 125 children with FAT who were treated with RFCA in the First Hospital of Tsinghua University from January 2010 to July 2018 were involved in the study. The clinical characteristics, origin of FAT, success rate of RFCA and recurrence rate and complications post RFCA were retrospectively analyzed, and the efficacy and X-ray radiation were compared between two-dimensional (2D) and 3D mapping system by t test or Chi-square analysis. Results: Among the 125 children, 57 were males and 68 females, age of (7.6±3.5) years old and body weight of (27.7±13.3) kg; and 62 (49.6%) had paroxysmal FAT, and 63 (50.4%) incessant FAT. Twenty-seven patients (21.6%) presented with tachycardia-induced cardiomyopathy (TIC), and 22 of whom (81.5%) were secondary to the incessant FATs. Most of the FATs originated from atrial auricle (46/125, 36.8%). Ablation was successful in 111 children (88.8%), and the recurrence rate was 25.2% (28/111). No complications were identified in the whole group. The efficacy and safety of 3D mapping system (87 cases) was better than that of the 2D mapping system (38 cases), according to the lower recurrence rate ((19.0% (15/79) vs. 40.6% (13/32), χ2 = 3.849, P=0.049), shorter X-ray exposure time ((4.9±2.3) vs. (12.5±5.7) min, t=7.942, P<0.01) and lower radiation doses ((5.3±3.3) vs. (10.9±3.7) mGy, t=8.038, P<0.01). Conclusions: FAT in children is mainly originated from atrial auricle, and incessant FAT is prone to progress to tachycardia-induced cardiomyopathy. RFCA is safe and effective for drug-resistant or drug-intolerant FAT in children, and 3D mapping system should be preferred.

Clinical and Electrophysiological Correlates of Incessant Ivabradine-Sensitive Atrial Tachycardia

Incessant focal atrial tachycardia (FAT), if untreated, can lead to ventricular dysfunction and heart failure (tachycardia-induced cardiomyopathy). Drug therapy of FAT is often difficult and ineffective. The efficacy of ivabradine has not been systematically evaluated in the treatment of FAT. The study group consisted of patients with incessant FAT (lasting >24 hours) and structurally normal hearts. Patients with ventricular dysfunction as a consequence of FAT were not excluded. All antiarrhythmic drugs were discontinued at least 5 half-lives before the initiation of ivabradine. Oral ivabradine (adults, 10 mg twice 12 hours apart; pediatric patients: 0.28 mg/kg in 2 divided doses) was initiated in the intensive care unit under continuous electrocardiographic monitoring. A positive response was defined as the termination of tachycardia with the restoration of sinus rhythm or suppression of the tachycardia to <100 beats per minute without termination within 12 hours of initiating ivabradine. Twenty-eight patients (mean age, 34.6±21.5 years; women, 60.7%) were included in the study. The most common symptom was palpitation (85.7%) followed by shortness of breath (25%). The mean atrial rate during tachycardia was 170±21 beats per minute, and the mean left ventricular ejection fraction was 54.7±14.3%. Overall, 18 (64.3%) patients responded within 6 hours of the first dose of ivabradine. Thirteen of 18 ivabradine responders subsequently underwent successful catheter ablation. FAT originating in the atrial appendages was a predictor of ivabradine response compared with those arising from other atrial sites (P=0.046). Ivabradine-sensitive atrial tachycardia constitutes 64% of incessant FAT in patients without structural heart disease. Incessant FAT originating in the atrial appendages is more likely to respond to ivabradine than that arising from other atrial sites. Our findings implicate the funny current in the pathogenesis of FAT.

EFFICACY OF IVABRADINE IN THE MANAGEMENT OF FOCAL ATRIAL TACHYCARDIA

Focal atrial tachycardia (FAT) in patients with structurally normal hearts is an uncommon arrhythmia encountered in clinical practice. The role of ivabradine has not been systematically evaluated in the treatment of FAT. Patients with incessant FAT (lasting >24 hours) were included in the study.

The Left Atrial Roof - A Rare Cause of Incessant Focal Atrial Tachycardia

The Left Atrial Roof - A Rare Cause of Incessant Focal Atrial Tachycardia

Current management of focal atrial tachycardia in children: a multicenter experience.

Focal atrial tachycardia (FAT) is an uncommon cause of supraventricular tachycardia in children. Incessant FAT can lead to tachycardia-induced cardiomyopathy. There is limited information regarding the clinical course and management of FAT. This study characterizes current management strategies for FAT in children including the prevalence of spontaneous resolution and the role of catheter ablation. This is a retrospective chart review of pediatric patients with FAT managed between January 2000 and November 2010 at 10 pediatric centers. There were 249 patients with a median age at diagnosis of 7.2 (95% confidence interval, 5.8-10.4) years. Cardiomyopathy was observed in 28%. Resolution of FAT occurred in 89%, including spontaneous resolution without catheter ablation in 34%. Antiarrhythmic medications were used for initial therapy in 154 patients with control of FAT in 72%. Among first-line medications, β-blockers were the most common (53%) and effective (42%). Catheter ablation was successful in 80% of patients. FAT recurrence was less common with electroanatomic mapping compared with conventional mapping techniques (16% versus 35%; P=0.02). Patients were followed for a median of 2.1 (95% confidence interval, 1.8-2.6) years. FAT is managed successfully in most children. Current approaches are variable. Many patients have control of FAT with medications; however, catheter ablation is used for most patients. Spontaneous resolution is common for young children, emphasizing the role for delayed ablation in this group. Ablation is successful for all ages. Lower recurrence occurs when electroanatomic mapping techniques are used.

Diffuse Ventricular Fibrosis Is a Late Outcome of Tachycardia-Mediated Cardiomyopathy After Successful Ablation

Successful arrhythmia ablation normalizes ejection fraction (EF) in tachycardia-mediated cardiomyopathy, but recurrent heart failure and late sudden death have been reported. The aim of this study was to characterize the left ventricle (LV) of tachycardia-mediated cardiomyopathy patients long after definitive arrhythmia cure. Thirty-three patients with a history of successfully ablated incessant focal atrial tachycardia 64±36 months prior, and 20 healthy controls were recruited. At ablation, 18 patients had EF<50% (AT-low EF) that recovered within 3 months from 37±12 to 56±4% (P<0.001), whereas 15 patients had EF>55% (AT-normal EF). No subjects had EF of 50% to 55%. Subjects underwent echocardiography with speckle tracking and contrast-enhanced cardiac MRI with ventricular T1 mapping as an index of diffuse fibrosis. Contrast-enhanced cardiac MRI was performed using a clinical 1.5-T scanner and 0.2 mmol/kg gadolinium-diethylene triamine penta-acetic acid for contrast. Subject characteristics were similar across the 3 groups. Compared with AT-normal EF patients and controls, AT-low EF patients had lower EF (60±6 versus 64±4 and 65±4%; P<0.05), greater indexed LV end-diastolic volume (102±34 versus 84±14 and 85±16 mL/m(2); P<0.05), and greater indexed LV end-systolic volume (41±11 versus 31±7 and 30±8 mL/m(2); P<0.01) on contrast-enhanced cardiac MRI. Compared with controls, AT-low EF patients had reduced global LV corrected T1 time (442±53 versus 529±61; P<0.05) consistent with diffuse fibrosis. Tachycardia-mediated cardiomyopathy patients exhibit differences in LV structure and function including diffuse fibrosis long after arrhythmia cure, indicating that recovery is incomplete.

Incessant Focal Atrial Tachycardia: Prevalence and Outcomes

Incessant Focal Atrial Tachycardia: Prevalence and Outcomes

Incidence and Implications of Obstructive Sleep Apnoea in Patients Presenting for Atrial Fibrillation Ablation: A Prospective Study

Background: Incessant focal atrial tachycardia (AT)may be complicated by LV dysfunction. The aim was to characterise the incidence, ECG and EP features of incessant focal AT and identify predictors of tachycardia mediated cardiomyopathy (TCM). Methods: 82 of 345 (24%) pts with focal AT presenting for radiofrequency ablation between 1997 and 2008 were incessant. Incessant AT was defined as continuous tachycardia or recurrent paroxysms of tachycardia separated by ≤2 sinus beats. Results: The mean age was 42± 20 years, 57% were male and mean symptom duration was 5± 7 years. TCM was present in 30/82 (37%), defined as LVEF <50%. Pts with incessant AT and TCM were more likely to be younger (mean 39± 22 year vs. 45± 18 year, p= 0.02); have a slower tachycardia cycle length (TCL) (502± 131ms vs. 446± 106ms, p= 0.05) and slower mean heart rate in tachycardia (117± 21 bpm vs. 132± 33 bpm, p= 0.05) than incessant pts without TCM. Incessant tachycardia was more frequent from atrial appendage (AA, 16/19 (84%)) and pulmonary vein (PV, 26/44 (59%)) sites compared to other anatomic locations (combined, 15%) (p< 0.001). Appendage and PV sites were therefore associated with a higher incidence of TCM (AA: 42%; PV: 18%; other: 6%, p= 0.008). RFA was successfully performed in 76/82 (93%) pts at mean follow up of 22± 26months. In pts with TCM recoveryofLV functionwas seen in 29/30 (97%)pts atmean of 2.8 months. Conclusion: Incessant tachycardia is frequently complicated by TCM. AA and PV foci were more likely to be incessant and complicated by TCM. Incessant tachycardia and TCM was characterized by a slower TCL and mean heart rate than pts without TCMpossibly delaying clinical presentation.

Incessant focal atrial tachycardia: A surgically remediable cause of cardiomyopathy

Following electrophysiological study and intraoperative mapping, an 11-year-old girl with incessant automatic atrial tachycardia and clinical features of congestive cardiomyopathy underwent successful surgical excision of an ectopic focus localized to the right atrial appendage. Dramatic clinical improvement resulted, and echocardiographic indices of left ventricular function returned to normal over a 1 year follow-up period.