Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Characteristics and Outcomes of Atrial Tachycardia Originating from the Sinus Venosus during Catheter Ablation of Atrial Fibrillation

  • Park, Yae Min (Division of Cardiology, Korea University College of Medicine) ;
  • Kook, Hyungdon (Division of Cardiology, Korea University College of Medicine) ;
  • Kim, Woohyeon (Division of Cardiology, Korea University College of Medicine) ;
  • Lee, Son Ki (Division of Cardiology, Korea University College of Medicine) ;
  • Choi, Jong-Il (Division of Cardiology, Korea University College of Medicine) ;
  • Lim, Hong Euy (Division of Cardiology, Korea University College of Medicine) ;
  • Park, Sang Weon (Division of Cardiology, Korea University College of Medicine) ;
  • Kim, Young-Hoon (Division of Cardiology, Korea University College of Medicine)
  • Published : 2013.01.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: The sinus venosus (SV) is not a well known source of atrial tachycardia (AT), but it can harbor AT during catheter ablation of atrial fibrillation (AF). Subjects and Methods: A total of 1223 patients who underwent catheter ablation for AF were reviewed. Electrophysiological and electrocardiographic characteristics and outcomes after catheter ablation of AT originating from the SV were investigated. Results: Ten patients (0.82%) demonstrated AT from the SV (7 males, $53.9{\pm}16.0$ years, 6 persistent) during ablation of AF. The mean cycle length was $281{\pm}73$ ms. After pulmonary vein isolation and left atrial ablation, AF converted to AT from the SV during right atrial ablation in 2 patients, by rapid atrial pacing after AF termination in 7 patients, and during isoproterenol infusion in 1 patient. Positive P-waves in inferior leads were shown in most patients (90%). The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by $80{\pm}37$ ms during AT. Using $4.4{\pm}2.7$ radiofrequency focal applications, ATs were terminated and became no longer inducible in all. After ablation procedure, two patients showed transient right phrenic nerve palsy. After $19.9{\pm}14.8$ months, all but 1 patient were free of atrial tachyarrhythmia without complications. Conclusion: The AT which develops during AF ablation is rarely originated from SV, and its electrophysiologic characteristics may be helpful in guiding effective focal ablation.

Keywords

References

  1. Mesas CE, Pappone C, Lang CC, et al. Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: electroanatomic characterization and treatment. J Am Coll Cardiol 2004;44: 1071-9. https://doi.org/10.1016/j.jacc.2004.05.072
  2. Chugh A, Oral H, Lemola K, et al. Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation. Heart Rhythm 2005;2:464-71. https://doi.org/10.1016/j.hrthm.2005.01.027
  3. Chae S, Oral H, Good E, et al. Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation: mechanistic insights, results of catheter ablation, and risk factors for recurrence. J Am Coll Cardiol 2007;50:1781-7. https://doi.org/10.1016/j.jacc.2007.07.044
  4. Scherr D, Dalal D, Cheema A, et al. Automated detection and characterization of complex fractionated atrial electrograms in human left atrium during atrial fibrillation. Heart Rhythm 2007;4:1013-20. https://doi.org/10.1016/j.hrthm.2007.04.021
  5. Saoudi N, Cosío F, Waldo A, et al. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases; a Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 2001;22:1162-82. https://doi.org/10.1053/euhj.2001.2658
  6. Mohamed U, Skanes AC, Gula LJ, et al. A novel pacing maneuver to localize focal atrial tachycardia. J Cardiovasc Electrophysiol 2007;18:1-6.
  7. Jais P, Hocini M, Sanders P, et al. Long-term evaluation of atrial fibrillation ablation guided by noninducibility. Heart Rhythm 2006;3:140-5. https://doi.org/10.1016/j.hrthm.2005.11.012
  8. Calkins H, Brugada J, Packer DL, et al. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007;4:816-61. https://doi.org/10.1016/j.hrthm.2007.04.005
  9. Nam GB, Jin ES, Choi H, et al. Mechanism of regular atrial tachyarrhythmias during combined pulomonary vein isolation and complex fractionated electrogram ablation in patients with atrial fibrillation. Circ J 2010;74:434-41. https://doi.org/10.1253/circj.CJ-09-0622
  10. Rostock T, Drewitz I, Steven D, et al. Characterization, mapping, and catheter ablation of recurrent atrial tachycardias after stepwise ablation of long-lasting persistent atrial fibrillation. Circ Arrhythm Electrophysiol 2010;3:160-9. https://doi.org/10.1161/CIRCEP.109.899021
  11. Satomi K. Electrophysiological characteristics of atrial tachycardia after pulmonary vein isolation of atrial fibrillation. Circ J 2010;74:1051-8. https://doi.org/10.1253/circj.CJ-10-0248
  12. Haïssaguerre M, Hocini M, Sanders P, et al. Catheter ablation of longlasting persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol 2005;16: 1138-47. https://doi.org/10.1111/j.1540-8167.2005.00308.x
  13. Gonzalez MD, Erga KS, Rivera J, et al. Rate-dependent block in the sinus venosa of the swine heart during transverse right atrial activation: correlation between electrophysiologic and anatomic findings. J Cardiovasc Electrophysiol 2005;16:193-200. https://doi.org/10.1046/j.1540-8167.2004.40483.x
  14. Harada M, Osaka T, Yokoyama E, Takemoto Y, Ito A, Kodama I. Action potential characteristics in the sinus venosa of patients with and without atrial flutter. Circ J 2009;73:647-53. https://doi.org/10.1253/circj.CJ-08-0748
  15. Lin YJ, Higa S, Tai CT, et al. Role of the right atrial substrate in different types of atrial arrhythmias. Heart Rhythm 2009;6:592-8. https://doi.org/10.1016/j.hrthm.2009.02.019
  16. Jaïs P, Matsuo S, Knecht S, et al. A deductive mapping strategy for atrial tachycardia following atrial fibrillation ablation: importance of localized reentry. J Cardiovasc Electrophysiol 2009;20:480-91. https://doi.org/10.1111/j.1540-8167.2008.01373.x
  17. Kistler PM, Roberts-Thomson KC, Haqqani HM, et al. P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol 2006;48:1010-7. https://doi.org/10.1016/j.jacc.2006.03.058
  18. Tang CW, Scheinman MM, Van Hare GF, et al. Use of P wave configuration during atrial tachycardia to predict site of origin. J Am Coll Cardiol 1995;26:1315-24. https://doi.org/10.1016/0735-1097(95)00307-X
  19. Kistler PM, Kalman JM. Locating focal atrial tachycardias from P-wave morphology. Heart Rhythm 2005;2:561-4. https://doi.org/10.1016/j.hrthm.2004.12.013
  20. Qian ZY, Hou XF, Xu DJ, et al. An algorithm to predict the site of origin of focal atrial tachycardia. Pacing Clin Electrophysiol 2011;34:414-21. https://doi.org/10.1111/j.1540-8159.2010.02980.x
  21. Sacher F, Monahan KH, Thomas SP, et al. Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study. J Am Coll Cardiol 2006;47:2498-503. https://doi.org/10.1016/j.jacc.2006.02.050
  22. Sanchez-Quintana D, Cabrera JA, Climent V, Farré J, Weiglein A, Ho SY. How close are the phrenic nerves to cardiac structures? Implications for cardiac interventionalists. J Cardiovasc Electrophysiol 2005;16: 309-13. https://doi.org/10.1046/j.1540-8167.2005.40759.x

Cited by

  1. Successful Ablation for Atrial Tachycardia Originated from Sinus Venosa with Tachycardia-Induced Cardiomyopathy vol.2016, pp.None, 2013, https://doi.org/10.1155/2016/4865034