RT-91
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Ablation in ectopic atrial
tachycardia
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Catherine Klersy1,
Arturo Raisaro2, Alberto Bonoldi3, Jorge A. Salerno Uriarte4.
1Biometric Unit-Scientific Direction, 2Division of
Cardiology and 3Hospital Direction, IRCCS Policlinico San Matteo, 4University
of Pavia, Italy
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A hundred and sixteen patients with ectopic atrial
tachycardia underwent ablation procedure. We observed permanent ectopic atrial tachycardia
in 41, incessant - 12, and paroxysmal - in 63 patients. Evidence of dilated cardiomyopathy
was found in 34 (29.3%) patients and signs of dilated cardiomyopathy were observed in 54%
of patients with permanent or incessant forms of ectopic atrial tachycardia.
Electrophysiological investigation included routine preoperative tests and intraoperative
epicardial or endocardial mapping based on original technique suction electrodes and
pacemaker migration detection methods. Ectopic foci or arrhythmogenic zones were founed:
in right atrium - 48, left atrium - 16, interatrial septum - 47 and extracardially - in 5
cases. Ablation or isolation of the foci were performed by transvenous (17 patients) and
closed heart approach using cryogenic technique in 91, combined cryo-laser - 4, and laser
alone - 1 patient. In 3 cases excision of atrial auricles with detected inside ectopic
foci was performed. In 4 patients complete atrioventricular block was induced and cardiac
pacemaker was implanted.
Transvenous catheter ablation of ectopic atrial tachycardia was successful in 11 cases
(64.7%) included all 9 cases with foci localization in right and only in 2 of 8 (25%) in
left atrium. Mainly it was associated with technical problems.
After primary surgery positive results were obtained in 83 patients (71.6%). In 11
cases recurrency of ectopic atrial tachycardia was observed, but 8 of them underwent
successful re-surgery. In other 3 patients pharmacological treatment became effective
which was not observed before the surgery. Finally, arrhythmia-free results after surgery
were founded in 94.9% cases.
Despite more traumatic procedure in comparison with transvenous catheter approach
closed heart ablation have high effectivenes and can be recommended and successfully used
for termination and treatment of ectopic atrial tachycardia, especially when ectopic foci
are located in interatrial septum, left atrium or extracardially.
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Key Words
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Cardiac surgery – arrhythmias
ectopic atrial tachycardia, radiofrequency ablation, corridor procedure, Maze operation, R
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