RT-200
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Sustained atrial tachycardia.
Electrophysiological characteristics and effects of radiofrequency ablation
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Benito Musto, Ciro Cavallaro,
Antonio D'onofrio*, Carmine Musto, Filippo Vecchione, Ciro Caputo.
Divisione di Cardiologia, Ospedale V. Monaldi, Naples, *Divisione di Cardiologia,
Ospedale A. Cardarelli, Naples, Italy
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Abstract
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Radiofrequency catheter ablation is accepted therapy
for patients with sustained atrial tachycardia. We report results of our experience in 33
patients aged 32 ± 13 years. Tachycardia was permanent in 5 and intermittent in 28
patients. Arrhythmia lasted 1 to 17 years and was refractory to 2.4 ± 1.8 antiarrhythmic
drugs. Structural heart disease was present in 8 patients. The mechanism of arrhythmia was
enhanced automaticity in 21, intra-atrial reentry in 9 and sinus node reentry in 3
patients. The site of origin of the tachycardia was in the left atrium in 2 patients and
in the right atrium in 31 patients. The site of tachycardia was initially identified by P'
wave on standard surface electrocardiogram and then with endocardial mapping to identify
the site of earliest atrial activation (AP' interval). A pace mapping of atrial
tachycardia was performed in 23 patients. Arrhythmia was induced with atrial programmed
stimulation. If it was not induced isoproterenol was infused intravenously and electrical
stimulation repeated. Radiofrequency energy successfully terminated arrhythmia in 30/33
patients (90.9%), with 1-18 pulses (6.3 ± 3.4 pulses) of 8-45 seconds of duration.
Tachycardia stopped after 2.8 ± 3.1 seconds (1.1-9.5 seconds). AP' interval at successful
ablation sites ranged 20 to 60 msec (41 ± 9 msec). An AP' interval > 30 msec
was found in 29/30 patients (96.7%). Pace mapping in 21 successful ablation sites,
reproduced spontaneous activation sequence in 17/21 site (81%). In all these 17 patients
the AP' interval > 30 msec was found. Mechanical transient interruption of
arrhythmia was observed in 3 patients (9.1%). During follow-up of 25 ± 12 months (11-66
months) atrial tachycardia recurred in 3 patients. Long term efficacy of radiofrequency
ablation of atrial tachycardia was 27/33 patients (81.8%). Thus, radiofrequency catheter
ablation appears to be a safe and effective technique for the treatment of sustained
atrial tachycardia.
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Key Words
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Peadiatric arrhythmias- management
sustained atrial tachycardia, electrophysiologic patterns, radiofrequency catheter
ablation, atrial programmed stimulation, OA
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