Published Online
on December 22, 2003

A more recent version of this article appeared on January 6, 2004

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Submitted on May 7, 2003
Revised on September 29, 2003
Accepted on September 30, 2003

Focal Atrial Tachycardia. New Insight From Noncontact Mapping and Catheter Ablation

Satoshi Higa MD, Ching-Tai Tai MD, Yenn-Jiang Lin MD, Tu-Ying Liu MD, Pi-Chang Lee MD, Jin-Long Huang MD, Ming-Hsiung Hsieh MD, Yoga Yuniadi MD, Bien-Hsien Huang MD, Shih-Huang Lee MD, Kwo-Chang Ueng MD, Yu-An Ding MD, and Shih-Ann Chen MD^*

From the Division of Cardiology, Department of Medicine, National Yang-Ming, University School of Medicine, Taipei Veterans General Hospital, Taiwan. Dr Higa is a research fellow from Okinawa University, Okinawa, Japan.

^* To whom correspondence should be addressed. E-mail: epsachen{at}ms41.hinet.net.

Background--This study investigated the electrophysiologic characteristics, atrial activation pattern, and effects of radiofrequency (RF) catheter ablation guided by noncontact mapping system in patients with focal atrial tachycardia (AT).

Methods and Results--In 13 patients with 14 focal ATs, noncontact mapping system was used to map and guide ablation of AT. AT origins were in the crista terminalis (n=8), right atrial (RA) free wall (n=3), Koch triangle (n=1), anterior portion of RA-inferior vena cava junction (n=1), and superior portion of tricuspid annulus (n=1); breakout sites were in the crista terminalis (n=5), RA free wall (n=5), middle cavotricuspid isthmus (n=2), and RA-superior vena cava junction (n=2). ATs arose from the focal origins (11 ATs inside or at the border of low-voltage zone), with preferential conduction, breakout, and spread to the whole atrium. After applications of RF energy on the earliest activation site or the proximal portion of preferential conduction from AT origin, 13 ATs were eliminated without complication. During the follow-up period (8±5 months), 11 (91.7%) of the 12 patients with successful ablation were free of focal ATs.

Conclusions--Focal AT originates from a small area and spreads out to the whole atrium through a preferential conduction. Application of RF energy guided by noncontact mapping system was effective and safe in eliminating focal AT.

Key words: mapping • tachycardia • ablation

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