Published Online
on October 13, 2003

A more recent version of this article appeared on October 21, 2003

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Submitted on June 6, 2003
Revised on August 8, 2003
Accepted on August 13, 2003

Electrophysiological and Electrocardiographic Characteristics of Focal Atrial Tachycardia Originating From the Pulmonary Veins. Acute and Long-Term Outcomes of Radiofrequency Ablation

Peter M. Kistler MBBS, Prashanthan Sanders MBBS, Simon P. Fynn MRCP, Irene H. Stevenson MBBS, Azlan Hussin MBBS, Jitendra K. Vohra MD, Paul B. Sparks MBBS, PhD, and Jonathan M. Kalman MBBS, PhD^*

From the Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia.

^* To whom correspondence should be addressed. E-mail: jon.kalman{at}mh.org.au.

Background--The objective of this study was to describe the electrophysiological characteristics, anatomic distribution, and long-term outcome after focal ablation (RFA) of pulmonary vein (PV) atrial tachycardia (AT). Both atrial fibrillation (AF) and AT may be due to a rapidly firing focus in the PVs. Whether these represent two aspects of the same process is unknown.

Methods and Results--Twenty-seven patients with 28 PV(16%) ATs of a consecutive series of 172 undergoing RFA for focal AT are reported. The mean age was 39±16 years, with symptoms for 9±14 years resistant to 1.7±0.8 medications. AT occurred spontaneously or with isoproterenol in all patients and was not inducible with PES in any. The distribution of PV ATs was right superior PV, 11; left superior PV, 11; left inferior PV, 5; and right inferior PV, 1; 26of 28 foci (93%) were ostial. RFA was successful in 28 of 28 PV ATs acutely. RFA was focal in 25 of 28, with PV isolation of a single target vein in 3. There were 4 recurrences at a mean of 3.3 months. Repeat RFA was performed in all 4 and successful in 3 of 4. All but one recurrence occurred from the same site. Long-term success was achieved in 26 of 27 (96%) patients at mean follow-up of 25±22 months. No patients have had subsequent development of AF or AT from a different site.

Conclusions--PV AT has a distribution similar to PV AF, with a propensity to upper veins. However, the majority of foci are ostial, and only a small percentage occur from deep in the PV. Focal RFA is associated with high long-term success, with freedom from both AT from other sites and from AF. PV AT is a localized process and therefore may be different from PV AF.

Key words: tachycardia • fibrillation • catheter ablation • fibrillation

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