Catheter ablation of left atrial focal tachycardia guided by electroanatomic mapping and new insights into interatrial electrical conduction

Jun Dong, Bernhard Zrenner, Jürgen Schreieck, Isabel Deisenhofer, Martin Karch, Michael Schneider, Christian Von Bary, Sonja Weyerbrock, Yuehui Yin, Claus Schmitt

Research output: Contribution to journalArticle

Abstract

Background: Experience in catheter ablation of left atrial (LA) focal tachycardia and information about interatrial electrical connections during LA focal tachycardia are limited. Objectives: The purpose of this study was to describe our experience in electroanatomic mapping-guided catheter ablation of LA focal tachycardia and to investigate interatrial electrical connections during LA focal tachycardias. Methods: Thirty-three patients undergoing catheter ablation for LA focal tachycardia guided by electroanatomic mapping were reported. Interatrial electrical connections were analyzed in LA focal tachycardias with biatrial electroanatomic maps. Results: Of the 35 LA focal tachycardias (cycle length 309 ± 100 ms) mapped, 19 (54%) originated from the pulmonary veins (PVs), 6 (17%) from the mitral annulus, 3 (8.6%) from LA roof, 3 (8.6%) from LA posterior wall, 2 (5.7%) from LA appendage, and 2 (5.7%) from LA septum. Fourteen of the 19 PV tachycardias (74%) were located in proximity to PV ostia. In 14 (7 PV, 7 non-PV) LA focal tachycardias with biatrial electroanatomic maps, posterior right atrium breakthrough sites at the intercaval area were identified in 7 PV tachycardias and 1 non-PV tachycardia. Five of the 7 PV tachycardias used only the posterior breakthrough for interatrial propagation. Procedural success was achieved in 33 of 35 LA focal tachycardias (94%) in 31 patients. During 23 ± 19 months of follow-up, 2 patients (6%) had recurrence of ablated tachycardia, and 3 (10%) developed new LA focal tachycardias. Conclusions: The PVs and the mitral annulus were the main sources of LA focal tachycardias. The majority of PV tachycardias originated from PV ostia. A posterior interatrial connection appeared to play a major role in interatrial electrical propagation during PV tachycardias. Electroanatomic mapping facilitated precise localization of LA focal tachycardias and achievement of a high rate of ablation success.

Original languageEnglish (US)
Pages (from-to)578-591
Number of pages14
JournalHeart Rhythm
Volume2
Issue number6
DOIs
StatePublished - Jun 2005

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Catheter Ablation
Tachycardia
Pulmonary Veins
Veins
Atrial Septum
Atrial Appendage

Keywords

  • Atrium
  • Catheter ablation
  • Electrophysiology
  • Mapping
  • Tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Catheter ablation of left atrial focal tachycardia guided by electroanatomic mapping and new insights into interatrial electrical conduction. / Dong, Jun; Zrenner, Bernhard; Schreieck, Jürgen; Deisenhofer, Isabel; Karch, Martin; Schneider, Michael; Von Bary, Christian; Weyerbrock, Sonja; Yin, Yuehui; Schmitt, Claus.

In: Heart Rhythm, Vol. 2, No. 6, 06.2005, p. 578-591.

Research output: Contribution to journalArticle

Dong, J, Zrenner, B, Schreieck, J, Deisenhofer, I, Karch, M, Schneider, M, Von Bary, C, Weyerbrock, S, Yin, Y & Schmitt, C 2005, 'Catheter ablation of left atrial focal tachycardia guided by electroanatomic mapping and new insights into interatrial electrical conduction', Heart Rhythm, vol. 2, no. 6, pp. 578-591. https://doi.org/10.1016/j.hrthm.2005.03.014
Dong, Jun ; Zrenner, Bernhard ; Schreieck, Jürgen ; Deisenhofer, Isabel ; Karch, Martin ; Schneider, Michael ; Von Bary, Christian ; Weyerbrock, Sonja ; Yin, Yuehui ; Schmitt, Claus. / Catheter ablation of left atrial focal tachycardia guided by electroanatomic mapping and new insights into interatrial electrical conduction. In: Heart Rhythm. 2005 ; Vol. 2, No. 6. pp. 578-591.
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abstract = "Background: Experience in catheter ablation of left atrial (LA) focal tachycardia and information about interatrial electrical connections during LA focal tachycardia are limited. Objectives: The purpose of this study was to describe our experience in electroanatomic mapping-guided catheter ablation of LA focal tachycardia and to investigate interatrial electrical connections during LA focal tachycardias. Methods: Thirty-three patients undergoing catheter ablation for LA focal tachycardia guided by electroanatomic mapping were reported. Interatrial electrical connections were analyzed in LA focal tachycardias with biatrial electroanatomic maps. Results: Of the 35 LA focal tachycardias (cycle length 309 ± 100 ms) mapped, 19 (54{\%}) originated from the pulmonary veins (PVs), 6 (17{\%}) from the mitral annulus, 3 (8.6{\%}) from LA roof, 3 (8.6{\%}) from LA posterior wall, 2 (5.7{\%}) from LA appendage, and 2 (5.7{\%}) from LA septum. Fourteen of the 19 PV tachycardias (74{\%}) were located in proximity to PV ostia. In 14 (7 PV, 7 non-PV) LA focal tachycardias with biatrial electroanatomic maps, posterior right atrium breakthrough sites at the intercaval area were identified in 7 PV tachycardias and 1 non-PV tachycardia. Five of the 7 PV tachycardias used only the posterior breakthrough for interatrial propagation. Procedural success was achieved in 33 of 35 LA focal tachycardias (94{\%}) in 31 patients. During 23 ± 19 months of follow-up, 2 patients (6{\%}) had recurrence of ablated tachycardia, and 3 (10{\%}) developed new LA focal tachycardias. Conclusions: The PVs and the mitral annulus were the main sources of LA focal tachycardias. The majority of PV tachycardias originated from PV ostia. A posterior interatrial connection appeared to play a major role in interatrial electrical propagation during PV tachycardias. Electroanatomic mapping facilitated precise localization of LA focal tachycardias and achievement of a high rate of ablation success.",
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AU - Dong, Jun

AU - Zrenner, Bernhard

AU - Schreieck, Jürgen

AU - Deisenhofer, Isabel

AU - Karch, Martin

AU - Schneider, Michael

AU - Von Bary, Christian

AU - Weyerbrock, Sonja

AU - Yin, Yuehui

AU - Schmitt, Claus

PY - 2005/6

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N2 - Background: Experience in catheter ablation of left atrial (LA) focal tachycardia and information about interatrial electrical connections during LA focal tachycardia are limited. Objectives: The purpose of this study was to describe our experience in electroanatomic mapping-guided catheter ablation of LA focal tachycardia and to investigate interatrial electrical connections during LA focal tachycardias. Methods: Thirty-three patients undergoing catheter ablation for LA focal tachycardia guided by electroanatomic mapping were reported. Interatrial electrical connections were analyzed in LA focal tachycardias with biatrial electroanatomic maps. Results: Of the 35 LA focal tachycardias (cycle length 309 ± 100 ms) mapped, 19 (54%) originated from the pulmonary veins (PVs), 6 (17%) from the mitral annulus, 3 (8.6%) from LA roof, 3 (8.6%) from LA posterior wall, 2 (5.7%) from LA appendage, and 2 (5.7%) from LA septum. Fourteen of the 19 PV tachycardias (74%) were located in proximity to PV ostia. In 14 (7 PV, 7 non-PV) LA focal tachycardias with biatrial electroanatomic maps, posterior right atrium breakthrough sites at the intercaval area were identified in 7 PV tachycardias and 1 non-PV tachycardia. Five of the 7 PV tachycardias used only the posterior breakthrough for interatrial propagation. Procedural success was achieved in 33 of 35 LA focal tachycardias (94%) in 31 patients. During 23 ± 19 months of follow-up, 2 patients (6%) had recurrence of ablated tachycardia, and 3 (10%) developed new LA focal tachycardias. Conclusions: The PVs and the mitral annulus were the main sources of LA focal tachycardias. The majority of PV tachycardias originated from PV ostia. A posterior interatrial connection appeared to play a major role in interatrial electrical propagation during PV tachycardias. Electroanatomic mapping facilitated precise localization of LA focal tachycardias and achievement of a high rate of ablation success.

AB - Background: Experience in catheter ablation of left atrial (LA) focal tachycardia and information about interatrial electrical connections during LA focal tachycardia are limited. Objectives: The purpose of this study was to describe our experience in electroanatomic mapping-guided catheter ablation of LA focal tachycardia and to investigate interatrial electrical connections during LA focal tachycardias. Methods: Thirty-three patients undergoing catheter ablation for LA focal tachycardia guided by electroanatomic mapping were reported. Interatrial electrical connections were analyzed in LA focal tachycardias with biatrial electroanatomic maps. Results: Of the 35 LA focal tachycardias (cycle length 309 ± 100 ms) mapped, 19 (54%) originated from the pulmonary veins (PVs), 6 (17%) from the mitral annulus, 3 (8.6%) from LA roof, 3 (8.6%) from LA posterior wall, 2 (5.7%) from LA appendage, and 2 (5.7%) from LA septum. Fourteen of the 19 PV tachycardias (74%) were located in proximity to PV ostia. In 14 (7 PV, 7 non-PV) LA focal tachycardias with biatrial electroanatomic maps, posterior right atrium breakthrough sites at the intercaval area were identified in 7 PV tachycardias and 1 non-PV tachycardia. Five of the 7 PV tachycardias used only the posterior breakthrough for interatrial propagation. Procedural success was achieved in 33 of 35 LA focal tachycardias (94%) in 31 patients. During 23 ± 19 months of follow-up, 2 patients (6%) had recurrence of ablated tachycardia, and 3 (10%) developed new LA focal tachycardias. Conclusions: The PVs and the mitral annulus were the main sources of LA focal tachycardias. The majority of PV tachycardias originated from PV ostia. A posterior interatrial connection appeared to play a major role in interatrial electrical propagation during PV tachycardias. Electroanatomic mapping facilitated precise localization of LA focal tachycardias and achievement of a high rate of ablation success.

KW - Atrium

KW - Catheter ablation

KW - Electrophysiology

KW - Mapping

KW - Tachycardia

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