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
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Article info
Publication history
Published online: May 02, 2017
Footnotes
This work was supported by Grant 81270242 from the National Natural Science Foundation of China.
Identification
Copyright
© 2017 Heart Rhythm Society. All rights reserved.
