Incisional and nonincisional atrial macroreentry tachycardia in adult patients.
Causes, mapping, and long-term results of catheter ablation
Authors:
M. Fiala 1,2; J. Chovančík 1; P. Heinc 2; R. Neuwirth 1; I. Nykl 1; R. Nevřalová 1; M. Branny 1
Authors‘ workplace:
Kardiocentrum Nemocnice Podlesí, Třinec, přednosta prim MUDr. Marian Branny
1; I. interní klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. Jan Lukl, CSc.
2
Published in:
Vnitř Lék 2005; 51(11): 1236-1247
Category:
Original Contributions
Overview
Atrial macroreentry tachycardias (AMRT) independent of the conduction across the subeustachian isthmus represent a relatively rare group of different reentry circuits developing from individual arrhytmogenic substrates.
The purpose of the study is to present causes, mapping facilities, and the results of catheter ablation of these arrhythmias.
Patients and methods:
Forty-two patients (11 females), aged 57.2 ± 12.8 years, presenting with clinically significant AMRT, were referred to mapping and catheter ablation. Eighteen patients had known structural heart disease, in other 24 patients, no significant structural heart disease could be detected. Electroanatomic mapping was used in 33 (67 %) of 49 ablation procedures.
Results:
In 49 ablation procedures, 59 critical isthmuses were targeted and 70 morphologies of 61 rates of mappable AMRT were eliminated. Fifty-six AMRT morphologies (41 in the right atrium and 15 in the left atrium) of 49 rates (35 in the right atrium and 14 in the left atrium) were eliminated with linear radiofrequency (RF) lesion. Fourteen AMRT morphologies of 12 rates (in the right atrium) were eliminated with focal lesion. Type I atrial flutter was also ablated in 20 patients. Anatomical approach using linear lesions for unmappable AMRT was simultaneously employed in six of the patients. Immediately at the end of the last ablation procedure, noninducibility of any AMRT was achieved in 37 (88 %) patients; in 31 (97 %) of 32 patients with right AMRT, and in 6 (60 %) of 10 patients with left AMRT. During long-term follow- up of 34 ± 24.7 months, AMRT did not recur in 39 (93 %) patients. Seven (17 %) patients had paroxysmal atrial fibrillation in the postablation period.
Conclusion:
AMRT can occur as a result of different cardiopathies as well as without association with any significant heart disease, typically in multiple morphologies and rates. Anatomy of the atria and the propagation of the electric impulse during AMRT can be truly electroanatomically reconstructed and AMRT can be eliminated by focal or linear lesion with high success rate. Long-term outcome of catheter ablation is favorable and propensity to the atrial fibrillation is low.
Key words:
atrial macroreentry tachycardia – conventional mapping – electroanatomic mapping – catheter ablation
Sources
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Internal Medicine
2005 Issue 11
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