Circulation, Vol 86, 1138-1146, Copyright © 1992 by American Heart Association
EP Walsh, JP Saul, JE Hulse, LA Rhodes, AJ Hordof, JE Mayer and JE Lock
BACKGROUND. Ectopic atrial tachycardia (EAT) is a reversible cause of
cardiomyopathy but may be quite difficult to control with conventional
therapy. Transcatheter ablation with radiofrequency current was tested as
an alternative to medical or surgical treatment of this condition. METHODS
AND RESULTS. Twelve young patients (aged 10 months to 19 years) with
drug-resistant EAT were treated with direct transcatheter ablation of the
ectopic focus using radiofrequency (RF) energy. All had depressed left
ventricular contractility by echocardiographic criteria, involving
shortening fractions of 10-26% (median, 20%; normal, 28-35%). The EAT was
mapped to the left atrium in seven cases and to the right atrium in five.
Local atrial activation at the ectopic site preceded the onset of the
surface P wave by 20-60 msec (median, 42 msec). Tachycardia terminated
0.5-13.0 seconds (median, 2.0 seconds) into a successful RF application.
The ablation effectively eliminated EAT in 11 of 12 patients (92%), all of
whom were discharged in sinus rhythm without medications after a median
hospital stay of 48 hours. Ablation was unsuccessful in one patient with
diffuse dysplasia of the anterior right atrium, who eventually did well
after surgical resection of abnormal atrial tissue. Transient depression of
sinus node function was noted in one patient who had successful ablation of
an EAT focus in close proximity to the sinus node, although normal sinus
node function returned within 72 hours. No other complications were
encountered. During follow-up (3-21 months; median, 13 months), one patient
had recurrence of a slower and less-sustained EAT that was successfully
eliminated at a second ablation session. All others remained in sinus
rhythm, and all 12 subjects recovered normal ventricular function.
CONCLUSIONS. RF ablation appears to be a safe and effective therapeutic
option for drug-resistant ectopic atrial tachycardia and may be the
preferred first-line therapy for those patients with depressed ventricular
function.
ARTICLES
Transcatheter ablation of ectopic atrial tachycardia in young patients using radiofrequency current
Department of Cardiology, Children's Hospital, Boston, MA 02115.
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