Should the Aortic Root Be the Preferred Route for Ablation of Focal Atrial Tachycardia Around the AV Node? Support From Intracardiac Echocardiography /

OBJECTIVES: The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. BACKGROUND: Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mappi...

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Bibliographic Details
Main Authors: Pap Róbert
Makai Attila
Szilágyi Judit
Klausz Gergely
Bencsik Gábor
Forster Tamás
Sághy László
Format: Article
Published: 2016
Series:JACC: CLINICAL ELECTROPHYSIOLOGY 2 No. 2
doi:10.1016/j.jacep.2015.10.005

mtmt:3379906
Online Access:http://publicatio.bibl.u-szeged.hu/16247
Description
Summary:OBJECTIVES: The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. BACKGROUND: Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mapping has been eliminated by ablation at the RA para-Hisian region, from the left atrium (LA) or the noncoronary aortic cusp (NCC). However the optimal approach has not been determined. METHODS: We conducted a retrospective analysis of a consecutive series of 148 patients undergoing catheter ablation for FAT between 2006 and 2014 in our institution. RESULTS: Earliest activation was recorded in the peri-AV nodal region during RA mapping in 34 patients (23%). Of these, 7 patients (20.5%) had successful ablation at the RA septum, using either radiofrequency (n = 4) or cryoenergy (n = 3). Seven FATs (20.5%) were ablated from the LA at the region of the aortomitral continuity, and 20 patients (59%) had successful ablation in the NCC, including 1 patient with a recurrence after a temporarily successful cryoablation from the RA. The proportion of the 3 approaches in this series showed a significant temporal evolution and overall frequency favoring ablation in the NCC (p = 0.011 for time trend and 0.013 for actual vs. expected frequencies). Intracardiac echocardiography proved superior catheter stability with the NCC approach. There were 2 cases of atrioventricular block and 1 recurrence after RA ablation versus no complications or recurrent FAT with NCC and LA approaches. CONCLUSIONS: Most peri-AV nodal FATs can be safely and effectively ablated from the NCC. The strategy of preferential NCC approach avoids RA para-Hisian ablation with the accompanying risk of AV block.
Physical Description:193-199
ISSN:2405-500X