Radiofrequency Ablation of Focal Atrial Tachycardia from Coronary Sinus

  • Muhammad Reza Department of Cardiology and Vascular Medicine University of Indonesia, Jakarta
  • Dicky A A Hanafy 1Department of Cardiology and Vascular Medicine University of Indonesia, Jakarta
  • Yanuar B. Hartanto Department of Cardiology and Vascular Medicine Diponegoro University, Semarang
  • Sunu B Raharjo Department of Cardiology and Vascular Medicine University of Indonesia, Jakarta
  • Yoga Yuniadi Department of Cardiology and Vascular Medicine University of Indonesia, Jakarta
Keywords: focal atrial tachycardia (AT), electrophysiology study, pacing maneuver, radiofrequency ablation (RFA)

Abstract

Focal atrial tachycardia (AT) is defined as atrial activation originating from a discrete focus with centrifugal spread. Available information suggests that focal activity can be caused by automaticity, triggered activity, or microreentry. Generally, AT response poorly to medication but can be treated by radiofrequency ablation with high long-term success. Focal AT represents approximately 3% to 17% of the patients referred for supraventricular tachycardia (SVT) radiofrequency ablation (RFA). Electrophysiology study is important to correctly diagnose the mechanism of the SVT before RFA is performed. Observation and several pacing maneuver could be done to identify the mechanism of SVT.A 54 year old female came with chief complaint of palpitation. During palpitation her ECG showed narrow complex regular tachycardia with the P-wave that was difficult to ascertain clearly. Electrophysiology study showed VA interval 130 ms, differences between VA interval during tachycardia and VA interval during RV pacing was 55 ms, no advanced in atrial activation, difference between ventricular post pacing interval (PPI) and tachycardia cycle length (TCL) was 130 ms, ventricular pacing during tachycardia results in V-A-A-V response before tachycardia resumes, and showed concentric atrial activation with earliest point at CS 9-10, indicating an AT from coronary sinus origin. AT was terminated during the RFA.Electrophysiology study is important to correctly diagnose AT, especially when P-wave during tachycardia in the surface ECG is uncertain. Several pacing maneuver during electrophysiology study can be very helpful to verify the diagnosis of AT.

Downloads

Download data is not yet available.

References

Rosso R, Kistler PM. Focal Atrial Tachycardia. Heart. 2010;96:181-85.

Zipes IM. Approach to paroxysmal supraventricular tachycardias. In: Andjelkovic laN, ed. Clinical arrhythmology and electrophysiology: A companion to braunwald’s heart disease. Philadelphia: Elsevier. 2009;157-158,377.

Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2016;67;e27–115.

Kanjwal K, George A, Mainigi SK. Establishing the mechanism of supraventricular tachycardia in electrophysiology laboratory. The Journal of Innovations in Cardiac Rhythm Management. 4 (2013);1217–1230.

Saoudi N, Cosio F, Waldo A, et al. Classification of atrial flutter and regular atrial tachycardia according to electrophysiologic mechanism and anatomic 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. Journal of cardiovascular electrophysiology. 2001;12:852-866.

Kistler PM, Roberts-Thomson KC, Haqqani HM. 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.

Badhwar N, Lee KB, Olgin JE. Ablation of Focal Atrial Tachycardias. In: Huang SKS, Wood MA. Catheter Ablation of Cardiac Arrhythmias, 2nd Edition. Philadelphia: Saunders. 2011;164-75.

Higa S, Tai CT, Chen SA. Focal Atrial Tachycardias. In: Wilber DJ, Packer DL, Stevenson WG. Catheter Ablation of Cardiac Arrhythmias, Third Edition. New York: Blackwell Futura. 2008;105-119.

Veenhuyzen GD, Quinn FN, Wilton SB, et al. Diagnostic Pacing Maneuvers for Supraventricular Tachycardia: Part 1. PACE. 2011;34:767–782.

Schaeffer B, Hoffmann BA, Meyer C, et al. Characterization, mapping, and ablation of complex atrial tachycardia: Initial experience with a novel method of ultra high-density 3D mapping. J Cardiovasc Electrophysiol. 2016;27:1139–1150.

Szegedi N, Zima E, Clemens M, et al. Radiofrequency ablation of focal atrial tachycardia: Benefit of electroanatomical mapping over conventional mapping. Acta Physiologica Hungarica. 2015;103:252-262.

Published
2017-04-18

Abstract viewed :
76 times
PDF downloaded : 75 times

How to Cite
Reza, M., Hanafy, D. A., Hartanto, Y., Raharjo, S., & Yuniadi, Y. (2017). Radiofrequency Ablation of Focal Atrial Tachycardia from Coronary Sinus. Indonesian Journal of Cardiology, 37(3), 145-55. https://doi.org/10.30701/ijc.v37i3.578
Section
Case Reports