Advertisement

Focal atrial tachycardias from the parahisian region: Strategies for mapping and catheter ablation

  • Jian-Du Yang
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Qi Sun
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Xiao-Gang Guo
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Gong-Bu Zhou
    Affiliations
    Department of Cardiology, Peking University Third Hospital, Beijing, China
    Search for articles by this author
  • Xu Liu
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Bin Luo
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Hui-Qiang Wei
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Jackson J. Liang
    Affiliations
    Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
    Search for articles by this author
  • Shu Zhang
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author
  • Jian Ma
    Correspondence
    Address reprint requests and correspondence: Dr. Jian Ma, State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
    Affiliations
    State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
    Search for articles by this author

      Background

      Focal atrial tachycardias (ATs) from the parahisian region can be successfully ablated from the right atrial septum (RAS), noncoronary cusp (NCC), and right middle septum (RMS). The optimal mapping and ablation strategy for ATs from these sites remains unclear.

      Objective

      The purpose of this study was to investigate the electrophysiologic characteristics and optimal ablation sites of parahisian ATs from the RAS, RMS, and NCC.

      Methods

      A total of 362 patients with ATs undergoing radiofrequency catheter ablation of ATs were included. A detailed examination including ECG analysis and electrophysiologic study was performed.

      Results

      Overall, 91 patients had a parahisian site of AT origin, and ablation was successful in 86 (94.5%). ATs were successfully eliminated from the RAS in 23, RMS in 19, and NCC in 44. The earliest “A” potential was recorded at the distal His catheter in 69.4% of NCC ATs vs the proximal His catheter in 83.3% of RAS ATs and 86.7% of RMS ATs. Mean timing of the “A” potential of RMS ATs recorded at the His-bundle catheter was –18.25 ± 7.20 ms, which was later than ATs from the RAS (–24.59 ± 8.73 ms) or NCC (–27.08 ± 5.63 ms). For ATs originating from the RAS and RMS, an A/V ratio <1.22 predicted safe and successful ablation (sensitivity 88.4%, specificity 91.7%).

      Conclusion

      For parahisian ATs, activation sequence and timing of the “A” on the His catheter can provide clues for the origin of ATs. When ablating at the RAS and RMS, an A/V ratio >1.22 identified safe and effective ablation sites.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      Reference

        • Kistler P.M.
        • Roberts-Thomson K.C.
        • Haqqani H.M.
        • Fynn S.P.
        • Singarayar S.
        • Vohra J.K.
        • Morton J.B.
        • Sparks P.B.
        • Kalman J.M.
        P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin.
        J Am Coll Cardiol. 2006; 48: 1010-1017
        • Lai L.P.
        • Lin J.L.
        • Chen T.F.
        • Ko W.C.
        • Lien W.P.
        Clinical, electrophysiological characteristics, and radiofrequency catheter ablation of atrial tachycardia near the apex of Koch's triangle.
        Pacing Clin Electrophysiol. 1998; 21: 367-374
        • Iesaka Y.
        • Takahashi A.
        • Goya M.
        • Soejima Y.
        • Okamoto Y.
        • Fujiwara H.
        • Aonuma K.
        • Nogami A.
        • Hiroe M.
        • Marumo F.
        • Hiraoka M.
        Adenosine-sensitive atrial reentrant tachycardia originating from the atrioventricular nodal transitional area.
        J Cardiovasc Electrophysiol. 1997; 8: 854-864
        • Tada H.
        • Naito S.
        • Miyazaki A.
        • Oshima S.
        • Nogami A.
        • Taniguchi K.
        Successful catheter ablation of atrial tachycardia originating near the atrioventricular node from the noncoronary sinus of Valsalva.
        Pacing Clin Electrophysiol. 2004; 27: 1440-1443
        • Chen C.C.
        • Tai C.T.
        • Chiang C.E.
        • Yu W.C.
        • Lee S.H.
        • Chen Y.J.
        • Hsieh M.H.
        • Tsai C.F.
        • Lee K.W.
        • Ding Y.A.
        • Chang M.S.
        • Chen S.A.
        Atrial tachycardias originating from the atrial septum: electrophysiologic characteristics and radiofrequency ablation.
        J Cardiovasc Electrophysiol. 2000; 11: 744-749
        • Das S.
        • Neuzil P.
        • Albert C.M.
        • D'Avila A.
        • Mansour M.
        • Mela T.
        • Ellinor P.T.
        • Singh J.
        • Patton K.
        • Ruskin J.N.
        • Reddy V.Y.
        Catheter ablation of peri-av nodal atrial tachycardia from the noncoronary cusp of the aortic valve.
        J Cardiovasc Electrophysiol. 2008; 19: 231-237
        • Liu X.
        • Dong J.
        • Ho S.Y.
        • Shah A.
        • Long D.
        • Yu R.
        • Tang R.
        • Hocini M.
        • Haissaguerre M.
        • Ma C.
        Atrial tachycardia arising adjacent to noncoronary aortic sinus: distinctive atrial activation patterns and anatomic insights.
        J Am Coll Cardiol. 2010; 56: 796-804
        • Ouyang F.
        • Ma J.
        • Ho S.Y.
        • et al.
        Focal atrial tachycardia originating from the non-coronary aortic sinus: electrophysiological characteristics and catheter ablation.
        J Am Coll Cardiol. 2006; 48: 122-131
        • Wang Z.
        • Ouyang J.
        • Liang Y.
        • Jin Z.
        • Yang G.
        • Liang M.
        • Li S.
        • Yu H.
        • Han Y.
        Focal atrial tachycardia surrounding the anterior septum: strategy for mapping and catheter ablation.
        Circ Arrhythm Electrophysiol. 2015; 8: 575-582
        • Yamada T.
        • Huizar J.F.
        • McElderry H.T.
        • Kay G.N.
        Atrial tachycardia originating from the noncoronary aortic cusp and musculature connection with the atria: relevance for catheter ablation.
        Heart Rhythm. 2006; 3: 1494-1496
        • Iwai S.
        • Badhwar N.
        • Markowitz S.M.
        • Stambler B.S.
        • Keung E.
        • Lee R.J.
        • Chung J.H.
        • Olgin J.E.
        • Scheinman M.M.
        • Lerman B.B.
        Electrophysiologic properties of para-Hisian atrial tachycardia.
        Heart Rhythm. 2011; 8: 1245-1253
        • Ju W.
        • Chen M.
        • Yang B.
        • Chen H.
        • Zhang F.
        • Li M.
        • Yu J.
        • Cao K.
        The role of noncoronary cusp ablation approach in the treatment of perinodal atrial tachycardias.
        Pacing Clin Electrophysiol. 2012; 35: 811-818
        • Zhou Y.F.
        • Wang Y.
        • Zeng Y.J.
        • Li X.L.
        • Zheng J.G.
        • Yang P.
        • Zhao X.
        • Liu X.F.
        • Gao Y.S.
        • Zhang H.
        • Peng W.H.
        Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from non-coronary sinuses of Valsalva in the aorta.
        J Interv Card Electrophysiol. 2010; 28: 147-151
        • Igawa O.
        Clinical Cardiac Structurology.
        Igaku-Shoin, Tokyo2011
        • Mukherjee R.
        • Laohakunakorn P.
        • Welzig M.C.
        • Cowart K.S.
        • Saul J.P.
        Counterintuitive relations between in vivo RF lesion size, power, and tip temperature.
        J Interv Card Electrophysiol. 2003; 9: 309-315
        • Huang S.K.S.
        • Miller J.M.
        Catheter Ablation of Cardiac Arrhythmias.
        Third Edition. Elsevier, Philadelphia2015: 410-413