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Outcomes of junctional ectopic tachycardia ablation in adult population—a multicenter experience

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Idiopathic junctional ectopic tachycardia (JET) is typically refractory to antiarrhythmic agents. Catheter ablation for JET is feasible but is associated with high risk of unintended atrioventricular (AV) block. There is limited data on the appropriate procedural technique and clinical outcomes with catheter ablation for idiopathic JET in adults.

Methods

This is a multicenter, retrospective study of all adult patients (age ≥ 18 years) who underwent catheter ablation for idiopathic JET. Patient, procedural characteristics, and long-term outcomes were evaluated.

Results

Fifteen patients [radiofrequency ablation (RF) = 14 and cryoablation = 1) were treated with catheter ablation. The median age was 58 years with 67% males. All patients underwent mapping of the right atrium and the aortic cusps prior to energy delivery. The location of earliest activation in relation to the atrioventricular (AV) node was postero-superior in 73% (11/15), posterior in 13% (2/15), and superior in 13% (2/15) respectively. Acute success was 100%. Arrhythmia recurrence occurred in 53% (8/15) all of whom underwent a repeat ablation. High-grade AV block requiring permanent pacemaker occurred in 20% (3/15). At 12-month follow-up in the redo-ablation group, 37.5% (3/8) had recurrence of the arrhythmia two of which underwent a third ablation procedure.

Conclusion

Catheter ablation of idiopathic JET in adults is associated with a high rate of recurrence requiring multiple procedures and high risk of AV block requiring a permanent pacemaker. Mapping and ablation of the non-coronary cusp can be considered as the arrhythmia was controlled in 3 patients with no inadvertent AV block.

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Abbreviations

JET:

Junctional ectopic tachycardia

SVT:

Supraventricular tachycardia

AVNRT:

Atrioventricular nodal reentry tachycardia

RFA:

Radiofrequency ablation

NCC:

Non-coronary cusp

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Author notes

  1. Tawseef Dar and Mohit K. Turagam have contributed equally and are co – first authors on this manuscript

Authors and Affiliations

  1. The Kansas City Heart Rhythm Institute (KCHRI), HCA MidWest, Overland Park, KS, 66221, USA

    Tawseef Dar, Mohit K. Turagam, Bharath Yarlagadda, Valay Parikh & Dhanunjaya Lakkireddy

  2. Mount Sinai Hospital – Icahn School of Medicine, New York, NY, USA

    Mohit K. Turagam

  3. Division of Cardiovascular Medicine, University of Texas, San Antonio, TX, USA

    Jayasree Pillarisetti

  4. Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, USA

    Rakesh Gopinathannair

  5. Texas Cardiac Arrhythmia Institute, Austin, TX, USA

    Carola Gianni, Sanghamitra Mohanty & Andrea Natale

  6. Massachusetts General Hospital, Boston, MA, USA

    Moussa Mansour

  7. Department of Medicine (Cardiology), Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY, USA

    Luigi Di Biase

  8. Intermountain Medical Center, Salt Lake City, UT, USA

    T. Jared Bunch

Authors
  1. Tawseef Dar
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Correspondence to Dhanunjaya Lakkireddy.

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Dar, T., Turagam, M.K., Yarlagadda, B. et al. Outcomes of junctional ectopic tachycardia ablation in adult population—a multicenter experience. J Interv Card Electrophysiol 61, 19–27 (2021). https://doi.org/10.1007/s10840-020-00749-3

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  • DOI: https://doi.org/10.1007/s10840-020-00749-3

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