Author + information
- Received April 10, 1992
- Revision received July 30, 1992
- Accepted October 15, 1992
- Published online March 15, 1993.
- Cynthia M. Tracy, MD, FACC∗,a,b,
- John F. Swartz, MD, FACCa,b,
- Ross D. Fletcher, MD, FACCa,b,
- Harry G. Hoops, HM2, USNa,b,
- Allen J. Solomon, MDa,b,
- Pamela E. Karasik, MDa,b and
- Diane Mukherjee, MDa,b
- ↵∗Address for correspondence: Cynthia M. Tracy, MD, Division of Cardiology, M 4213, Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, D.C. 20007.
Objectives. Although ectopic atrial tachycardia is infrequent, it can be an important clinical challenge. We sought to define an alternative therapeutic approach to this refractory problem.
Background. Radiofrequency energy catheter ablation has been used to treat a variety of ventricular and supraventricular arrhythmias but has not been proved afficacious in the management of ectopic atrial tachycardia.
Methods. Ten patients (14 to 47 years of age) referred with refractory ectopic atrial tachycardia were studied. Mapping techniques included identification of earliest atrial activation, confirmation of concordance of P wave configuration during spontaneous tachycardia and pacing from the ablation catheter, and paced activation sequence mapping. The paced activation sequence mapping compared the activation sequence at multiple atrial sites during spontaneous tachycardia with that recorded during pacing from the ablation catheter. The catheter was steered to a point where pacing reproduced the spontaneous activation sequence.
Results. Foci were right atrial in eight patients and left atrial in two. In 8 of 10 patients, 514 ± 97 (SE) J and 5.7 ± 2.3 (SD) J radiofrequency energy applications ablated the ectopic focus. Seven of these eight patients presented with one focus and one had two discrete and stable foci. Ablation was unsuccessful in two patients with multiple foci. No complications occurred. An arrhythmia focus recurred in two patients and one patient underwent successful repeat ablation. The other patient was managed medically. All seven patients with successful ablation are symptom free after (6.5 ± 3.8 months.
Conclusions. Our preliminary experience suggests that with the use of both paced activation sequence mapping and standard techniques, radiofrequency ablation of ectopic atrial tachycardia may be a safe and effective form of therapy.
☆ The opinions or assertions contained herein are the private ones of the authors and are not to be construed as official or reflectiin the views of the Department of Defense, the US Air Force or the Uniformed Services University of Helth Sciences, Bethesda, Maryland.
- Received April 10, 1992.
- Revision received July 30, 1992.
- Accepted October 15, 1992.