| Scar-related right atrial macroreentrant tachycardia in patients without prior atrial surgery: electroanatomic characterization and ablation outcome. | |
MedLine Citation:
|
PMID: 15922265 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Few descriptions of right atrial macroreentrant atrial tachycardia involving regions of spontaneous "scar" have been reported. OBJECTIVES: We describe the electrocardiographic, electrophysiologic, and electroanatomic characteristics of an unusual RA macroreentrant atrial tachycardia in eight patients with spontaneous RA scarring. METHODS: Eight of 286 patients with macroreentrant atrial tachycardia treated with radiofrequency ablation had RA spontaneous scarring and underwent conventional electrophysiologic studies and electroanatomic mapping. RESULTS: Eight patients (age 53 +/- 12 years) had symptoms for 58 +/- 62 months and had not responded to 2.5 +/- 0.8 antiarrhythmic drugs and 1.0 +/- 0.9 DC cardioversions. All patients had overall normal systolic function, and five had mild atrial enlargement. Scarring was present in the posterolateral wall extending from the crista terminalis toward the tricuspid annulus. The proportion of RA classified as scar was 31% +/- 14% (range 11%-46%). Stable circuits were around scar in seven patients, through a "channel" within the scar in four, and typical cavotricuspid isthmus-dependent flutter in five. Radiofrequency ablation sites included the cavotricuspid isthmus; between the inferior vena cava, superior vena cava, or crista terminalis and scar; or a channel in the scar. ECG morphology of the RA free wall tachycardias varied, depending upon whether cavotricuspid isthmus block was present. Radiofrequency ablation of all inducible circuits was successful in six patients and of all clinical circuits in seven. At follow-up of 20 +/- 13 months, six patients are free from macroreentrant atrial tachycardia, one has infrequent nonsustained macroreentrant atrial tachycardia, and one is controlled with previously ineffective medication. Five had sinus node dysfunction requiring permanent pacemaker implant. CONCLUSIONS: Extensive spontaneous scarring of the RA is an unusual cause of macroreentrant atrial tachycardias, both cavotricuspid isthmus dependent and independent in the same patient. Radiofrequency ablation is an effective treatment. Sinus node dysfunction requiring permanent pacemaker is common. The cause is unknown. |
Authors:
|
Irene H Stevenson; Peter M Kistler; Steven J Spence; Jitendra K Vohra; Paul B Sparks; Joseph B Morton; Jonathan M Kalman |
Related Documents
:
|
7631615 - Conversion of atrial flutter in pediatric patients by transesophageal atrial pacing: a ... 10348565 - Transcatheter closure of ventricular septal defects using the rashkind device: initial ... 15998925 - Ximelagatran: an orally active direct thrombin inhibitor. 11208685 - Chemical cardioversion of atrial fibrillation or flutter with ibutilide in patients rec... 21785225 - Elevated cystatin c levels predict the incidence of vasospastic angina. 6629605 - Systemic lupus erythematosus and diffuse soft tissue calcifications. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: 2 ISSN: 1547-5271 ISO Abbreviation: Heart Rhythm Publication Date: 2005 Jun |
Date Detail:
|
Created Date: 2005-05-30 Completed Date: 2005-10-04 Revised Date: 2009-10-27 |
Medline Journal Info:
|
Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: United States |
Other Details:
|
Languages: eng Pagination: 594-601 Citation Subset: IM |
Affiliation:
|
Department of Cardiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Catheter Ablation* Cicatrix / physiopathology Electrophysiologic Techniques, Cardiac* Female Humans Male Middle Aged Tachycardia, Atrioventricular Nodal Reentry / physiopathology, surgery* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Catheter ablation of left atrial focal tachycardia guided by electroanatomic mapping and new insight...
Next Document: Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans.