Heart Rhythm
Volume 6, Issue 2 , Pages 198-203, February 2009

Electrophysiologic characteristics and catheter ablation of focal atrial tachycardia with more than one focus

  • Yu-Feng Hu, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • Division of Cardiology, Department of Medicine, Taipei Medical University Hospital, Taipei, Taiwan
    • ,
  • Satoshi Higa, MD, PhD

      Affiliations

    • Second Department of Internal Medicine, Faculty of Medicine, University of Ryukyus, Okinawa, Japan
    • ,
  • Jin-Long Huang, MD, PhD

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • Heart Failure Division, Cardiovascular Center, Taichung Veterans General Hospital, Taipei, Taiwan
    • ,
  • Ching-Tai Tai, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Yenn-Jiang Lin, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Shih-Lin Chang, MD, FHRS

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Li-Wei Lo, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Ta-Chuan Tuan, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Chien-Jong Chang, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Wen-Chin Tsai, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Pi-Chang Lee, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Sugako Ishigaki, MD

      Affiliations

    • Second Department of Internal Medicine, Faculty of Medicine, University of Ryukyus, Okinawa, Japan
    • ,
  • Asuka Oyakawa, MD

      Affiliations

    • Second Department of Internal Medicine, Faculty of Medicine, University of Ryukyus, Okinawa, Japan
    • ,
  • Shih-Ann Chen, MD, FHRS

      Affiliations

    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
    • Corresponding Author InformationAddress reprint requests and correspondence: Dr. Shih-Ann Chen, Division of Cardiology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, Taiwan

Received 11 August 2008; accepted 27 October 2008. published online 03 November 2008.

Background

Information about the electrophysiologic characteristics and long-term outcome of catheter ablation in patients with multiple focal atrial tachycardia (AT) is limited.

Objective

The purpose of this study was to investigate the electrophysiologic characteristics and long-term outcome of catheter ablation in patients with multiple focal AT.

Methods

Two hundred fifty-one patients who were referred for radiofrequency catheter ablation of focal AT were included for analysis.

Results

Forty-four patients who had focal AT with more than one focus were identified. Comparing focal AT with a single focus to that with more than one focus, the existence of a left atrial focus, cardiovascular comorbidity, nonparoxysmal tachycardia, shortest tachycardia cycle length, success rate of the ablation, and procedure time all differed. Multivariate logistic analysis revealed that a left atrial focus, cardiovascular comorbidity, and shortest tachycardia cycle length were independent predictors of focal AT with more than one focus. Noncontact mapping of the right atrium revealed larger low-voltage zone and longer total activation time for focal AT with more than one focus. Patients who had focal AT with more than one focus and a failed ablation had a greater number of focal ATs and mechanisms of nonparoxysmal tachycardia. Multivariate logistic analysis revealed that only the number of focal ATs predicted a failed ablation.

Conclusion

Focal ATs with more than one focus have different electrophysiologic characteristics. This study provides new insight into the development and atrial remodeling of focal AT with multiple foci.

Keywords: Focal atrial tachycardia, Catheter ablation, Atrial substrate

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 This study is supported by research grants from the Taipei Veterans General Hospital (V96C1-049, V97C1-059), National Scientific Council (NSC95-2314-B-010-017, NSC95-2314-B-010-025, NSC96-2314-B-010-006, NSC96-2628-B-010-036), Research Foundation of Cardiovascular Medicine, (RFCM 96-02-018).

 There are no conflicts of interest to report.

PII: S1547-5271(08)01078-3

doi:10.1016/j.hrthm.2008.10.041

Heart Rhythm
Volume 6, Issue 2 , Pages 198-203, February 2009

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