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Resumen Se presenta el caso de un paciente de 68 años con aleteo auricular perimitral recurrente a terapia antiarrítmica en el seguimiento de ablación de venas pulmonares por fibrilación auricular. En este caso no se logra el control de la arritmia a pesar de una aproximación usual; se aplica radiofrecuencia endoepicárdica del istmo mitral. En vista de lo anterior, se decide realizar alcoholización de la vena de Marshall; una técnica rápida, útil y efectiva en el control de esta arritmia. A continuación, se describe el paso a paso con el objetivo de familiarizar a los cardiólogos intervencionistas con esta técnica. A la fecha, el paciente se encuentra en ritmo sinusal y sin recurrencia de la arritmia en el seguimiento.
Abstract The case of a 68-year-old patient with recurrent perimitral atrial flutter to anti-arrhythmic therapy in the follow-up of pulmonary vein ablation due to atrial fibrillation is presented. In our case, arrhythmia control is not achieved despite a usual approach; Endo-epicardial radiofrequency application at the mitral isthmus level. Given the above, it was decided to alcoholize Marshalls vein; a fast, useful and effective technique in the control of this arrhythmia. Here is a step-by-step guide to familiarize interventional cardiologists with this technique. The patient is in sinus rhythm and without recurrence of the arrhythmia at follow-up.
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Atrial fibrillation is the most common persistent arrhythmia in the clinic. It affects a wide range of populations with high incidence, morbidity and mortality. Clinical studies have shown that ablation is one of the best means for the treatment of atrial fibrillation. However, after receiving ablation, some patients may experience atrial tachycardia and thus feel even deteriorated feelings. Understanding the predicting factors, electrophysiological mechanisms, and differential diagnosis and treatment strategies for post-ablation atrial tachycardia is essential for reducing the incidence and for the management of post-ablation atrial tachycardia. Therefore, we summarize the research progress of the above-mentioned aspects, and correspondingly proposes further research directions.
Subject(s)
Humans , Atrial Fibrillation , Catheter Ablation , Tachycardia, Supraventricular/surgery , Treatment OutcomeABSTRACT
Abstract Management of symptomatic atrial tachycardia (AT) during pregnancy seems challenging, especially those originating from left atrial appendage (LAA), which easily tend to be incessant and mediate cardiomyopathy. It's contradictory between therapy and pregnancy. In this study, we report a case of a woman who presented with persistent AT, which lead to heart failure, during early pregnancy. She underwent successful catheter ablation using CartoSound and electroanatomic mapping without fluoroscopy. An electrophysiology (EP) study confirmed a focal LAA tachycardia. Soon after, left ventricular function of her heart normalized, and the patient successfully delivered a healthy child.
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications, Cardiovascular/surgery , Atrial Fibrillation/surgery , Catheter Ablation/methods , Atrial Appendage/surgery , Pregnancy Complications, Cardiovascular/diagnostic imaging , Atrial Fibrillation/diagnostic imaging , Atrial Appendage/diagnostic imaging , Electrocardiography , ElectrophysiologyABSTRACT
This case discusses a patient who presented with symptoms of dyspnea and cough. Prior to being seen and admitted, the patient was seen multiple times over a one month period with complaints of intermittent chest pain, most notable in the retrosternal region, and frequent heart palpitations. Cardiac monitoring of the patient revealed multifocal atrial tachycardia over multiple ECG, the cause of which was later revealed to be a pericardial cyst located in the right atrium on CT scan and transesophageal echocardiogram.
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Objectives: To analyze the electrophysiological mapping characteristic and evaluate the effect of radiofrequency ablation in atrial tachycardia (AT) originating from the non-coronary aortic cusp (NCC). Methods: Data from 11 patients with AT originated from NCC and underwent electrophysiological mapping and radiofrequency ablation under the guidance of three-dimensional mapping system were analyzed. The electrical anatomical model of right atrium, His bundle and the root of the aorta was constructed during the procedure to measure the distance between the earliest atrial activation and His bundle. Ablation was performed at the earliest atrial activation site. Results: Cardiac electrophysiological examination evidenced the focal originating of AT in all 11 cases, right atrial activation mapping showed that all the earliest activation site was located in the left or left upper posterior of His bundle, activation time was (21.0 ± 7.9) ms prior to coronary sinus proximal reference wave A, the distance between the earliest activation site and the His bundle was (6.9 ± 3.4) mm. Aortic root mapping showed that the earliest activation sites were all located in the NCC, activation time was (35.0 ± 8.6) ms prior to coronary sinus proximal reference wave A, the distance between the earliest activation site and His bundle was (7.3 ± 4.6) mm. AT in all 11 patients were terminated after ablation, Post ablation, AT could no longer be induced by repeated stimulations. No atrioventricular conduction block occurred during and after operation. No AT recurrences were observed in all 11 patients during the 6 months follow-up. Conclusions: The success rate and safety of three-dimensional mapping guided ablation of AT originated from NCC are high. The main point of the mapping, which is crucial for the successful ablation, is that if the earliest atrial activation site of AT is located at left or left upper posterior of His bundle, it is mandatory to perform aortic root mapping and to routinely determine whether NCC is the earliest activation site of AT.
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Objective The recurrence of perimitral atrial tachycardia is common after initial ablation of persistent atrial fibrillation (AF). The aim of the study is to explore a preferable ablation approach for perimitral atrial tachycardia in the redo ablation of persistent AF. Methods Seventy-four patients with perimitral atrial tachycardia after initial ablation for persistent AF were included in our study. Patients were distinguished into either the group of having ablation during tachycardia (Group A) or the group having ablation after cardioversion to sinus rhythm (Group B) according to the different ablation strategies. The procedural endpoints were pulmonary vein isolation and bidirectional conduction block of all the ablated lines. The primary endpoint of the study was freedom from atrial tachyarrhythmia recurrence during the follow-up period. Results There were statistical differences in baseline clinical data between the 2 groups. During the redo procedure, conduction recovery rate across the mitral isthmus (MI),cavotricuspid isthmus and left atial roofline were 100％, 40.5％ and 48.6％ respectively. The procedural time, fluoroscopy time, mapping time were longer in the patients of group A. During a mean follow-up of (16.9±6.3) months, 31 (72.1％) patients in group A and 21(67.7％) patients in group B maintained in sinus rhythm in the absence of antiarrhythmic durgs (P =0.771) . Conclusion In patients with perimitral atrial tachycardia after initial ablation for persistent AF,ablation in sinus rhythm is a more simplified method and as effective as ablation during tachycardia.
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Objective To analyze the clinical characteristics and follow-up data of catheter ablation of recurrent atrial tachycardias (ATs) after Mini-Maze surgery,and to explore prognostic factors for recurrence.Methods 59 patients in Guangdong General Hospital with ATs post Mini-Maze and concomitant open-heart surgery from April.2010 to June.2015 were included.According to high density precise mapping,activation mapping,voltage mapping and entrainment mapping,they underwent electrophysiological study and ablation which was guided by three-dimensional mapping system.All patients were followed up regularly.We explored the prognostic factors for recurrence by the Cox regression analysis.Results There were 88 types of ATs being mappedwith mean (1.49 ± 0.75) types of ATs identified per case.Most ATs were macro-reentry ATs(67/88,76.1％)and focal ATs (20/88,22.7％),respectively.56 patients (94.9％) achieved immediate ablation success.In a mean follow-up of (30.8 ± 17.7) months,recurrences were observed in 12 patients after the first time catheter ablation.Recurrent time was 3.5 (1.3,12.0) months and the overall ablation success rate was 74.6％ (44/59).6 patients received second ablation and the achievement of freedom from arrhythmias reached 79.7％ (47/59).Multivariate analysis showed that the LA diameter was the independent predictor for recurrence (HR 1.108,95％ CI 1.002 to 1.226,P =0.045).Conclusion Catheter ablation of ATs post Mini-Maze with concomitant surgery is save and feasible.LA diameter is the independent predictor for recurrence.
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The inferior vena cava (IVC) is a rare site of focal atrial tachycardia (AT). Here, we report a 20-year-old woman who underwent catheter ablation for anti-arrhythmic drug-resistant AT originating from the IVC. She had undergone open-heart surgery for patch closure of an atrial septal defect 17 years previously and permanent pacemaker implantation for sinus node dysfunction 6 years previously. The AT focus was at the anterolateral aspect of the IVC-right atrial junction, and it was successfully ablated under three-dimensional electroanatomical-mapping guidance. We suspect that the mechanism of this tachycardia was associated with previous IVC cannulation for open-heart surgery.
Subject(s)
Female , Humans , Young Adult , Catheter Ablation , Catheterization , Heart Septal Defects, Atrial , Sick Sinus Syndrome , Tachycardia , Vena Cava, InferiorABSTRACT
Objective To investigate the electrophysiological characteristics of atrial tachycardia (AT) originating from the side of the bundle of His, and to analyze the efficacy and safety of transcatheter radiofrequency ablation via the right side of the bundle of His and left noncoronary sinus of aorta for the treatment of AT. Methods A total of 12 patients with AT originating from the side the bundle of His, which was confirmed by conventional electrophysiological study and atrial activation patterns, were included in this study. The patient’s age ranged from 12 to 64 years old with a mean of (47.4±14.6) years. The mapping was carried out at the right side of the bundle of His and radiofrequency ablation was performed. When the ablation procedure failed, or the junction zone rhythm or atrioventricular block occurred, ablation via the left noncoronary sinus of aorta was employed. Results Atrial stimulation could repeatedly induce and terminate AT in all the 12 patients, the average cycle length was (327±76) ms. TA was terminated within 10 seconds after the start of ablation in 10 patients during their AT attacks. Ablation was unsuccessful in 2 patients. Ablation via the right side of His bundle was successfully accomplished in 2 patients, and the ablation via the left noncoronary sinus of aorta was successfully carried out in 8 patients. The average follow-up time was 1-6 years, and no recurrence of AT was observed. Conclusion Atrial tachycardia originating from the side of the bundle of His has certain electrophysiological characteristics, and transcatheter radiofrequency ablation is safe and effective for its treatment. Ablation via the left noncoronary sinus of aorta should be considered as a strategy of priority.
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We reported a case of a 55-year-old patient who presented with palpitation after swallowing. Initial surface electrocardiogram revealed ventricular preexcitation utilizing a left lateral bypass tract. The orthodromic atrioventricular reentrant tachycardia (AVRT) was induced during electrophysiologic studies. After successful ablation of the AVRT utilizing a left lateral free wall bypass tract, 2 different atrial tachycardias (ATs) were induced under isoproterenol infusion. When the patient swallowed saliva or drank water, 2 consecutive beats of atrial premature complexes (APCs) preceded another non-sustained AT repeatedly, which was coincident with the patient's symptom. The preceding APC couplet had the same activation sequence with one induced AT, and the subsequent non-sustained AT had the same activation sequence with the other induced AT, respectively. We first targeted the preceding 2 consecutive APCs at the left posterior interatrial septum. The following non-sustained AT was also eliminated following ablation of the APCs. After ablation, the patient remained free from the swallowing-induced atrial tachyarrhythmias during the one year follow-up.
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Humans , Middle Aged , Atrial Premature Complexes , Catheter Ablation , Deglutition , Electrocardiography , Follow-Up Studies , Isoproterenol , Saliva , Tachycardia , Water , Wolff-Parkinson-White SyndromeABSTRACT
Objective To evaluate the feasibility of catheter ablation of Para-Hisian Atrial Tachycardia guide by CARTO. Method Catheter ablation guided by CARTO was performed after activation map in three patients with Para-Hisian Atrial Tachycardia. Result Successful ablation was got at right atrial in two patients and at non-coronary in one patient. Conclusion Catheter ablation guided by CARTO is safe and efficient for Para-Hisian Atrial Tachycardia.
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Objective To study the clinical characteristics of children with chaotic atrial tachycardia (CAT),and to improve its clinical diagnosis and treatment.Methods Clinical data,follow-up,treatment and prognosis concerning 33 patients with CAT from Sep.2001 to Oct.2013 in Beijing Children's Hospital were analyzed.Results The 33 patients included 23 boys and 10 girls with ages ranging from 3 days to 13 months,5 months on the average.CAT was conformed by electrocardiogram in all patients:multifocal atrial tachycardia defined by 3 distinct P'-waveforms,irregular P'R,RR and P'-P' intervals,and isoelectric baseline between P'-waves.Combined with symptoms of atrial flutter,atrial fibrillation,atrial premature beats,atrial tachycardia,and interior conduction,differences were detected by 24-hour holter electrocardiography.Echocardiographic features indicated mild heart enlargement in 19 cases,medium enlargement in 4 cases,severe enlargement in 3 cases,atrial septal defect in 5 cases,ventricular septal defect in 3 cases,atrial septal defect coupled with patent ductus arteriosus in 1 case,congenital total anomalous pulmonary venous cormection in 1 case,and patent foramen ovale closure in 12 cases.Twenty-three patients had heart failure.Digoxine,amiodarone and Betaloc were administered to the patients for maintaining their heart functions.No antiarrhythmic drug therapy was used in 2 patients.Twenty-six of the patients (78.8％) had normal electrocardiographic sinus rhythm within 3 to 18 months after their discharge from hospital.Three of the patients (9.1％) still had CAT symptoms in their eletroccardiogram,but their heart rates were kept under control during the 12-month follow-up clinical visits.Of 26 children with cardiac enlargement,echocardiograms in 21 cases (80.8％) returned to normal within 1-3 months after their electrocardiograms returned to normal,and for the other 5 cases (19.2％),the recovery took 6-12 months.One patient died and 3 patients did not participate in the follow-up visits.Conclusions CAT is often found in newborns and infants.Its diagnosis relies on electrocardiography and 24-hour holter electrocardiography.Treatment with Digoxine,and/or β-receptor block,and amiodarone according to with the heart functions of patients can restore sinus rhythm,and achieve good prognostic results.
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Objective To identify the electrophysiological charateristics and cause of ridge gap related reentry after MI ablation in atrial ifbrillation patients. Methods Activation and entrainment mapping was performed in 82 redo cases for OAT recurrence in whom MI was ablated during the index produre. Once ridge gap related reentry was conifrmed, detailed mapping was performed in MI and ridge region. In addition, in 36 cases undergoing MI ablation and fulfilling criterion for bidirectional block, differential pacing was repeated at the ridge to identify a ridge gap. Results Out of 82 redo cases for OAT recurrence in whom MI was ablated during the index produre, 7 (8.5%) was found to be ridge gap related reentry. TCL was (247.9±19.2) ms, and the left atrial endocardial activation time was (145.4±17.7) ms, accounting for (58.5±3.2)%of TCL. However, wide double potential was recorded along the previous ablated MI line where PPI was (34.3±6.6) ms longer than TCL, while PPI was signiifcantly shorter at the ridge[PPI-TCL (11.4±3.9) ms, P<0.001]. Tachycardia was terminated at the ridge in 6 cases and at the corresponding site in coronary sinus in 1 case. No recurrence was found during follow-up for (11.1±4.5) months. In addition, in 36 patients undergoing MI ablation in whom criterion of bi-directional block was fuliflled, conduction gap located at the ridge was found in 5 (13.9%) cases. Conclusions MI ridge gap related reentry is a distinctive OAT, in which the ridge was used as the critical isthmus, whereas the previous ablated MI line is not part of the reentry. MI pseudo-block due to the ridge gap may lead to this type of recurrent tachycardia.
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Atrial tachycardia (AT) originating from the aortomitral junction is a very rare and challenging disease. Its arrhythmic characteristics have not been described in detail compared with the descriptions of the arrhythmic characteristics of AT originating from the other locations. Only a few case reports have documented successful ablation of this type of AT using transaortic or transseptal approaches. We describe a case with AT that was resistant to right-sided ablation near the His bundle failed and transaortic ablation at the aortomitral junction successfully eliminated.
Subject(s)
Bundle of His , Catheter Ablation , TachycardiaABSTRACT
Introducción. La cardiomiopatía dilatada idiopática es la forma más común de cardiomiopatía en niños; sin embargo, ocasionalmente son identificadas causas potencialmente reversibles. Entre estas existe un grupo de pacientes con manifestaciones de insuficiencia cardiaca y taquicardia persistente que representan una forma de cardiomiopatía no familiar adquirida conocida como cardiomiopatía inducida por taquicardia o taquicardiomiopatía, que es reversible con el tratamiento efectivo de la taquicardia. Estos pacientes pueden ser mal diagnosticados y tratados de forma inapropiada. El diagnóstico frecuentemente es tardío, por lo que debe sospecharse en pacientes con insuficiencia cardiaca y taquicardia persistente sin causa aparente. Casos clínicos. Se describen seis casos de pacientes pediátricos de 6 a 16 años de edad (media 12 ± 4 años) que se presentaron con manifestaciones clínicas de insuficiencia cardiaca. Tuvieron seguimiento por una forma de cardiomiopatía dilatada en los que se documentaron diferentes mecanismos de taquiarritmia persistente como la causa. El tratamiento apropiado -mediante ablación con catéter- condujo a la recuperación de la función ventricular. Conclusiones. Es importante el reconocimiento de la cardiomiopatía inducida por taquiarritmia en pediatría. También es necesario un diagnóstico oportuno así como un tratamiento eficaz, ya que la cardiomiopatía inducida por taquicardia es una causa reversible de insuficiencia cardiaca.
Background. Idiopathic dilated cardiomyopathy is the most common form of cardiomyopathy in children; however, potentially reversible causes may occasionally be identified. Among these a group of patients with symptoms of congestive heart failure and persistent tachycardia representing a form of nonfamilial acquired cardiomyopathy known as tachycardia-induced cardiomyopathy or tachycardiomyopathy. This is a reversible condition with effective treatment of tachycardia. These patients may be misdiagnosed, potentially leading to inappropriate treatment. Diagnosis is often late and always should be suspected in patients with congestive heart failure and unexplained persistent tachycardia. Case reports. We describe six pediatric patients (mean age 12 ±4 years old, range 6-16 years). Patients presented with clinical manifestations of heart failure followed by dilated cardiomyopathy. Different mechanisms of persistent tachycardia were documented as the cause and total recovery was achieved of ventricular function after successful treatment of tachycardia by catheter ablation. Conclusions. The recognition of tachyarrhythmia-induced cardiomyopathy in pediatric patients is important. Opportune diagnosis and effective treatment are necessary because tachycardia-induced cardiomyopathy is a reversible cause of heart failure.
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Objective To investigate the correlation between various types of atrial tachycardia (AT) and tachycardia-induced cardiomyopathy(TIC) in children and to assess the risk factors for the development of TIC.Methods Patients with AT were divided into 2 groups depending on whether complicated with TIC or not,defined as left ventricular ejection fraction(LVEF) ＜ 50％ on echocardiography.The presence of atrial rhythm in Holter monitoring,ventricular rate of AT,and the type of AT onset were compared between the 2 groups; the risk factors associated with TIC were also analyzed.Results Totally 72 patients were enrolled in this study.The incidence of TIC was 23.6％.The incidence of TIC in patients presenting incessant tachycardia was significantly higher than that of patients presenting paroxysmal tachycardia(53.6％ vs 4.5％,P ＜ 0.01).Patients with TIC had a higher mean atrial rhythm percent [(98 ± 5) ％ vs (37 ± 4) ％,P ＜ 0.001] and faster mean ventricular rate [(134.25 ± 19.24) beats/min vs (100.03 ± 18.83) beats/min,P ＜ 0.05] compared with those without TIC.After successful control of tachycardia,LVEF in patients with TIC gradually recovered within 6 to 75 days [(29.44 ± 21.62) days].Conclusions An incessant AT with higher percent of atrial rhythm and faster mean ventricular rate is more frequently complicated by cardiomyopathy.Recovery of TIC can be achieved after successful control of AT.Early intervention and treatment should be performed for those with high risk factors for the development of TIC.
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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+/-16.0 years, 6 persistent) during ablation of AF. The mean cycle length was 281+/-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+/-37 ms during AT. Using 4.4+/-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+/-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.
Subject(s)
Humans , Male , Atrial Fibrillation , Catheter Ablation , Catheters , Electrocardiography , Heart Atria , Isoproterenol , Paralysis , Phrenic Nerve , Pulmonary Veins , Tachycardia , Vena Cava, SuperiorABSTRACT
Atrial tachycardia is a relatively uncommon form of SVT. Atrial tachycardia can be observed in persons with normal heart and in those with congenital heart disease and particularly after surgery for repair or correction of congenital or valvular heart disease. Atrial tachycardia tends to be refractory to pharmacologic therapy and is therefore frequently treated with ablative therapy. If untreated, it may lead to tachycardia-induced cardiomyopathy. So, atrial tachycardia needs to be discussed for recognition and appropriate management. We have gone through different journals to review the latest informations about atrial tachycardia
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Las taquicardias auriculares focales pueden originarse en distintas regiones de la aurícula derecha, incluidos la crista terminalis, el anillo tricuspídeo, el septum interauricular y la orejuela derecha. Las originadas en esta última región anatómica se caracterizan por presentar un comportamiento incesante y mala respuesta al tratamiento farmacológico antiarrítmico, con desarrollo de taquicardiomiopatía; su tratamiento de elección es la ablación por radiofrecuencia.Presentamos el caso de una infante de 36 meses de edad, con taquicardiomiopatía secundaria a taquicardia auricular incesante de orejuela derecha, a quien se le realizó ablación por radiofrecuencia.
Focal atrial tachycardias originate from different anatomic regions of the right atrium including the crista terminalis, the coronary sinus ostium, the tricuspid annulus, the interatrial septum and the right atrial appendage. The latter are characterized by being incessant and presenting poor response to antiarrhythmic treatment. They frequently evolve into tachycardiomyopathy and radiofrequency ablation is the treatment of choice. We present the case of a 36 month old girl with tachycardiomyopathy as a result of an incessant atrial tachycardia originated in the right atrial appendage. Patient underwent radiofrequency ablation.