Author + information
- Received July 28, 1987
- Revision received December 23, 1987
- Accepted December 31, 1987
- Published online May 1, 1988.
- A.Allen Seals, MD,
- Gerald M Lawrie, MD, FACC,
- Sharon Magro, PAC,
- Huang-Ta Lin, MD, FACC,
- Antonio Pacifico, MD,
- Robert Roberts, MD, FACC and
- Christopher R.C Wyndham, MD, FACC∗
- ↵∗Address for reprints: Christopher R. C. Wyndham, MD, Section of Cardiology, Baylor College of Medicine. The Methodist Hospital, 6535 Fannin Street, F905, Houston, Texas 77030.
Although successful operative treatment of atrial focal tachycardia has been reported in children, there are only isolated reports of surgical treatment of this arrhythmia in adults. In this case series of eight patients (aged 10 to 53 years) with drug-resistant right atrial focal tachycardia, results of electrophysiologic studies, surgical techniques and long-term follow-up are described. Atrial focai tachycardia was reproduced during etectrophysiologic study, and endocardial mapping localized the earliest onset of atrial activation in the right atrium in all patients.
Epicardial mapping confirmed the location of atrial tachycardia foci in seven of eight patients whose tachycardia was inducible intraoperatively. Of four patients treated with epicardial cryoablation alone, two had recurrent tachycardia and required a second procedure. None have had arrhythmia recurrence, in all four patients aftar right atrial excision (two of whom had intraoperative recurrence of atrial focal tachycardia alter epicardial cryoablation alone), there has been no recurrence during a clinical follow-up period of 11 to 67 mouths (mean 30).
It is concluded that in adult patients 1) electrophysiologic study with endocardial and epicardial mapping permits successful surgical treatment of atrial focal tachycardia; 2) epicardial cryoablation alone may be associated with recurrence of atrial focal tachycardia either intraoperatively or postoperatively; and 3) subtotal right atrial resection appears to be a well tolerated procedure with no long-term recurrence of atrial focal tachycardia.
☆ This study was presented in part at the 7th Annual Scientific Session of the North American Society of Pacing and Electrophysiology, May 1986, New Orleans, Louisiana. Computational assistance was provided by the CLINFO Project and was funded by Grant RR-00350 from the Division of Research Resources, National Institutes of Health, Bethesda, Maryland.
- Received July 28, 1987.
- Revision received December 23, 1987.
- Accepted December 31, 1987.