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Focal atrial tachycardia arising from the mitral annulus: electrocardiographic and electrophysiologic characterization.

Abstract：

OBJECTIVES:The study was done to characterize the electrocardiographic and electrophysiologic features of focal atrial tachycardia originating at the mitral annulus (MA). BACKGROUND:Though the majority of left atrial tachycardias originate around the ostia of the pulmonary veins, only isolated reports have described focal tachycardia originating from the MA. METHODS:Seven patients of a consecutive series of 172 patients undergoing radiofrequency ablation for focal atrial tachycardia are reported. Electrophysiologic study involved catheters positioned along the coronary sinus (CS), crista terminalis (CT), His bundle, and a mapping/ablation catheter. RESULTS:All seven patients had tachycardia foci originating from the superior region of the MA in close proximity to the left fibrous trigone and mitral-aortic continuity. These foci demonstrated a characteristic P-wave morphology and endocardial activation pattern. The P-wave morphology in the precordial leads typically showed a biphasic pattern, with an inverted component followed by an upright component. The P-wave was consistently of low amplitude in the limb leads. Earliest endocardial activity occurred at the His bundle region in all seven patients. In general, CS activation was proximal to distal, and mid-CT activation was earlier than high or low CT. Ablation was successful at the superior aspect of the MA in all patients. CONCLUSIONS:The MA is an unusual but important site of origin for focal atrial tachycardia, with a propensity to be localized to the superior aspect. It can be suspected as a potential anatomic site of tachycardia origin from analysis of P-wave morphology and the atrial endocardial activation sequence map. Using mapping targeted to anatomic structures achieved a high success rate for ablation.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kistler PM,Sanders P,Hussin A,Morton JB,Vohra JK,Sparks PB,Kalman JM

doi

10.1016/s0735-1097(03)00484-4

subject

Has Abstract

pub_date

2003-06-18 00:00:00

pages

2212-9

issue

eissn

0735-1097

issn

1558-3597

pii

S0735109703004844

journal_volume

pub_type

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Focal atrial tachycardia arising from the mitral annulus: electrocardiographic and electrophysiologic characterization.