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Electrophysiologic Properties of Para-Hisian Atrial Tachycardia.
MedLine Citation:
PMID:  21397044     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Focal atrial tachycardia (AT) originates from preferential sites, including the tricuspid and mitral annuli. AT arising from the atrioventricular annuli is initiated and terminated with programmed stimulation, and is, in general, adenosine- and verapamil-sensitive. Para-Hisian AT arising from the apex of the Triangle of Koch has been considered to be a distinct entity, characterized by unique electrophysiologic properties. OBJECTIVE:: We sought to more fully delineate the electrophysiologic and electrocardiographic properties of para-Hisian AT in a large series of patients. METHODS:: The study population consisted of 38 pts (63 ± 15 yrs; 23 F) with AT from the para-Hisian region. The ATs were focal and originated from the anteroseptal tricuspid annulus, in close proximity to the His bundle recording. Proximity to the His bundle was confirmed by electrogram recordings, fluoroscopy and centrifugal activation pattern on three-dimensional mapping system. RESULTS:: The mean AT cycle length was 421 ± 69 ms. AT was associated with distinct P wave morphology that was significantly narrower than P wave during sinus rhythm. Adenosine (5.0 ± 1.5 mg) terminated AT in 34/35 patients. Intravenous verapamil terminated AT in 3/3 patients; diltiazem terminated AT in 1/1 patient. Catheter ablation was attempted in 30 pts and was successful in 26 (87%). CONCLUSION:: The para-Hisian region is a source of focal AT, with properties consistent with AT arising circumferentially along the tricuspid and mitral annuli, and should be considered a subset of this broader group of "annular" ATs. The electropharmacologic findings in para-Hisian AT are mechanistically consistent with cyclic AMP-mediated triggered activity.
Sei Iwai; Nitish Badhwar; Steven M Markowitz; Bruce S Stambler; Edmund Keung; Randall J Lee; Jeffrey H Chung; Jeffrey E Olgin; Melvin M Scheinman; Bruce B Lerman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-9
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, NY.
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