Should the Aortic Root Be the Preferred Route for Ablation of Focal Atrial Tachycardia Around the AV Node? Support from Intracardiac Echocardiography

Robert Pap, Attila Makai, Judit Szilágyi, Gergely Klausz, Gábor Bencsik, T. Forster, László Sághy

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objectives The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. Background Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mapping has been eliminated by ablation at the RA para-Hisian region, from the left atrium (LA) or the noncoronary aortic cusp (NCC). However the optimal approach has not been determined. Methods We conducted a retrospective analysis of a consecutive series of 148 patients undergoing catheter ablation for FAT between 2006 and 2014 in our institution. Results Earliest activation was recorded in the peri-AV nodal region during RA mapping in 34 patients (23%). Of these, 7 patients (20.5%) had successful ablation at the RA septum, using either radiofrequency (n = 4) or cryoenergy (n = 3). Seven FATs (20.5%) were ablated from the LA at the region of the aortomitral continuity, and 20 patients (59%) had successful ablation in the NCC, including 1 patient with a recurrence after a temporarily successful cryoablation from the RA. The proportion of the 3 approaches in this series showed a significant temporal evolution and overall frequency favoring ablation in the NCC (p = 0.011 for time trend and 0.013 for actual vs. expected frequencies). Intracardiac echocardiography proved superior catheter stability with the NCC approach. There were 2 cases of atrioventricular block and 1 recurrence after RA ablation versus no complications or recurrent FAT with NCC and LA approaches. Conclusions Most peri-AV nodal FATs can be safely and effectively ablated from the NCC. The strategy of preferential NCC approach avoids RA para-Hisian ablation with the accompanying risk of AV block.

Original languageEnglish
Pages (from-to)193-199
Number of pages7
JournalJACC: Clinical Electrophysiology
Volume2
Issue number2
DOIs
Publication statusPublished - Apr 1 2016

Fingerprint

Atrioventricular Node
Tachycardia
Echocardiography
Heart Atria
Atrioventricular Block
Atrial Septum
Recurrence
Cryosurgery
Catheter Ablation
Catheters

Keywords

  • aortic root
  • aortomitral continuity
  • catheter ablation
  • focal atrial tachycardia
  • intracardiac echocardiography
  • noncoronary cusp

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Should the Aortic Root Be the Preferred Route for Ablation of Focal Atrial Tachycardia Around the AV Node? Support from Intracardiac Echocardiography. / Pap, Robert; Makai, Attila; Szilágyi, Judit; Klausz, Gergely; Bencsik, Gábor; Forster, T.; Sághy, László.

In: JACC: Clinical Electrophysiology, Vol. 2, No. 2, 01.04.2016, p. 193-199.

Research output: Contribution to journalArticle

Pap, Robert ; Makai, Attila ; Szilágyi, Judit ; Klausz, Gergely ; Bencsik, Gábor ; Forster, T. ; Sághy, László. / Should the Aortic Root Be the Preferred Route for Ablation of Focal Atrial Tachycardia Around the AV Node? Support from Intracardiac Echocardiography. In: JACC: Clinical Electrophysiology. 2016 ; Vol. 2, No. 2. pp. 193-199.
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abstract = "Objectives The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. Background Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mapping has been eliminated by ablation at the RA para-Hisian region, from the left atrium (LA) or the noncoronary aortic cusp (NCC). However the optimal approach has not been determined. Methods We conducted a retrospective analysis of a consecutive series of 148 patients undergoing catheter ablation for FAT between 2006 and 2014 in our institution. Results Earliest activation was recorded in the peri-AV nodal region during RA mapping in 34 patients (23{\%}). Of these, 7 patients (20.5{\%}) had successful ablation at the RA septum, using either radiofrequency (n = 4) or cryoenergy (n = 3). Seven FATs (20.5{\%}) were ablated from the LA at the region of the aortomitral continuity, and 20 patients (59{\%}) had successful ablation in the NCC, including 1 patient with a recurrence after a temporarily successful cryoablation from the RA. The proportion of the 3 approaches in this series showed a significant temporal evolution and overall frequency favoring ablation in the NCC (p = 0.011 for time trend and 0.013 for actual vs. expected frequencies). Intracardiac echocardiography proved superior catheter stability with the NCC approach. There were 2 cases of atrioventricular block and 1 recurrence after RA ablation versus no complications or recurrent FAT with NCC and LA approaches. Conclusions Most peri-AV nodal FATs can be safely and effectively ablated from the NCC. The strategy of preferential NCC approach avoids RA para-Hisian ablation with the accompanying risk of AV block.",
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AU - Pap, Robert

AU - Makai, Attila

AU - Szilágyi, Judit

AU - Klausz, Gergely

AU - Bencsik, Gábor

AU - Forster, T.

AU - Sághy, László

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N2 - Objectives The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. Background Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mapping has been eliminated by ablation at the RA para-Hisian region, from the left atrium (LA) or the noncoronary aortic cusp (NCC). However the optimal approach has not been determined. Methods We conducted a retrospective analysis of a consecutive series of 148 patients undergoing catheter ablation for FAT between 2006 and 2014 in our institution. Results Earliest activation was recorded in the peri-AV nodal region during RA mapping in 34 patients (23%). Of these, 7 patients (20.5%) had successful ablation at the RA septum, using either radiofrequency (n = 4) or cryoenergy (n = 3). Seven FATs (20.5%) were ablated from the LA at the region of the aortomitral continuity, and 20 patients (59%) had successful ablation in the NCC, including 1 patient with a recurrence after a temporarily successful cryoablation from the RA. The proportion of the 3 approaches in this series showed a significant temporal evolution and overall frequency favoring ablation in the NCC (p = 0.011 for time trend and 0.013 for actual vs. expected frequencies). Intracardiac echocardiography proved superior catheter stability with the NCC approach. There were 2 cases of atrioventricular block and 1 recurrence after RA ablation versus no complications or recurrent FAT with NCC and LA approaches. Conclusions Most peri-AV nodal FATs can be safely and effectively ablated from the NCC. The strategy of preferential NCC approach avoids RA para-Hisian ablation with the accompanying risk of AV block.

AB - Objectives The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. Background Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mapping has been eliminated by ablation at the RA para-Hisian region, from the left atrium (LA) or the noncoronary aortic cusp (NCC). However the optimal approach has not been determined. Methods We conducted a retrospective analysis of a consecutive series of 148 patients undergoing catheter ablation for FAT between 2006 and 2014 in our institution. Results Earliest activation was recorded in the peri-AV nodal region during RA mapping in 34 patients (23%). Of these, 7 patients (20.5%) had successful ablation at the RA septum, using either radiofrequency (n = 4) or cryoenergy (n = 3). Seven FATs (20.5%) were ablated from the LA at the region of the aortomitral continuity, and 20 patients (59%) had successful ablation in the NCC, including 1 patient with a recurrence after a temporarily successful cryoablation from the RA. The proportion of the 3 approaches in this series showed a significant temporal evolution and overall frequency favoring ablation in the NCC (p = 0.011 for time trend and 0.013 for actual vs. expected frequencies). Intracardiac echocardiography proved superior catheter stability with the NCC approach. There were 2 cases of atrioventricular block and 1 recurrence after RA ablation versus no complications or recurrent FAT with NCC and LA approaches. Conclusions Most peri-AV nodal FATs can be safely and effectively ablated from the NCC. The strategy of preferential NCC approach avoids RA para-Hisian ablation with the accompanying risk of AV block.

KW - aortic root

KW - aortomitral continuity

KW - catheter ablation

KW - focal atrial tachycardia

KW - intracardiac echocardiography

KW - noncoronary cusp

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