Comparison of strategies for catheter ablation of focal atrial tachycardia originating near the His bundle region.

Abstract

BACKGROUND Recent studies have suggested that para-Hisian atrial tachycardia (AT) can be successfully ablated from the right atrium (RA), left atrium (LA), or noncoronary cusp (NCC) in the aorta; however, the best approach remains unclear. OBJECTIVE This study aimed to compare different approaches to radiofrequency catheter ablation (RFCA) of para-Hisian AT. METHODS We retrospectively analyzed 68 consecutive patients (49[72%] women; mean age 61 ± 13 years) treated with RFCA for this type of AT. Mapping of the RA (n = 68), LA (n = 21), and NCC (n = 52) was performed during AT to identify the earliest activation site and to apply RFCA. RESULTS RFCA successfully terminated AT in the RA in 13 of 28 patients (46.4%), in the LA in 4 of 16 patients (25.0%), and in the NCC in 46 of 52 patients (88.5%) after 1 procedure (P < .05). Atrioventricular block occurred only during RFCA in the RA in 4 of 28 patients (14.3%). After a mean follow-up of 33.5 ± 25.4 months, AT recurrence was observed in 5 of 13 patients (38.5%) ablated in the RA, 1 of 4 (25.0%) ablated in the LA, and 2 of 46 (4.4%) ablated in the NCC (P < .05). RFCA in the LA was effective only if the local activation time (LAT) was earlier than that in the RA. RFCA in the NCC was successful regardless of the LAT (P < .05). CONCLUSION Mapping and ablation in the NCC should be always considered in cases of AT originating from the His bundle region, regardless of the LAT.

DOI: 10.1016/j.hrthm.2017.02.028

Cite this paper

@article{Lyan2017ComparisonOS, title={Comparison of strategies for catheter ablation of focal atrial tachycardia originating near the His bundle region.}, author={Evgeny Lyan and Mauro Toniolo and Alexey Tsyganov and Luca Rebellato and Alessandro Proclemer and Massimiliano Manfrin and Anatoly A. Nechepurenko and Alexandr Morozov and Ayan Abdrahmanov and Grigory Gromyko and Vitaly Lyashenko and Marina Yakovleva}, journal={Heart rhythm}, year={2017}, volume={14 7}, pages={998-1005} }