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Focal atrial tachycardia ablation: Highly successful with conventional mapping

  • Antonis S. ManolisEmail author
  • Kyriakos Lazaridis
Article
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Abstract

Background/objective

Radiofrequency catheter ablation (RFCA) of focal atrial tachycardia (FAT) traditionally is guided by conventional endocardial mapping of earliest atrial activation; however, more recently electro-anatomical mapping is heralded as a more effective, albeit more expensive, tool to guide ablation. Herein we present the results of conventional mapping-guided RFCA. Apropos, we conducted a literature search of studies reporting > 10 FAT patients submitted to RFCA.

Methods and results

Conventional mapping-guided RFCA, performed in 63 FAT patients (aged 42.4 + 17.3 years; 14 with incessant tachycardia and 12 with tachycardiomyopathy (TCM)), was successful in 61 (96.8%) patients, applied for single foci in 59 (93.7%) and two foci in 4 patients, right (n = 46) or left sided (n = 17). The earliest atrial activation time at the ablation site was 41.3 ± 16.2 ms. Fluoroscopy time averaged 27.3 + 18.7 min, and procedure lasted 2.6 + 1.7 h. Complications occurred in two patients (sinus pauses in one needing a pacemaker and a large inguinal hematoma in one). Over 29.0 + 22.9 months, four patients (6.5%) had recurrences, of whom three were successfully re-ablated. All patients with TCM showed gradual improvement to normalization over 4–6 months. Literature search showed that RFCA success is equally high when guided with either conventional (88.5%) or electro-anatomical mapping (90%) with similar recurrences (9.6% vs. 9.5%).

Conclusion

Conventional mapping-guided RFCA of FAT had high success (96.8%) with low complication (3.2%) and recurrence rates (6.5%). TCM was fully reversible. These results are comparable to those achieved with the more expensive electro-anatomical mapping, which may be reserved for more complex cases or for those failing the conventional approach.

Keywords

Radiofrequency catheter ablation Focal atrial tachycardia Supraventricular tachycardia Conventional mapping Endocardial activation Electro-anatomical mapping Tachycardiomyopathy Heart failure 

Abbreviations

AV

Atrioventricular

EAM

Electro-anatomical mapping

ECG

Electrocardiogram

FAT

Focal atrial tachycardia

LV

Left ventricle(ular)

LVEF

Left ventricular ejection fraction

RFCA

Radiofrequency catheter ablation

TCM

Tachycardiomyopathy

Notes

Compliance with ethical standards

All patients or patients’ parents gave informed written consent for the procedures.

Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. 1.Third Department of CardiologyAthens University School of MedicineAthensGreece
  2. 2.Cardiology DepartmentNIMTS HospitalAthensGreece

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