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Allen J Solomon – 1st expert on this subject based on the ideXlab platform
radiofrequency catheter ablation of ectopic Atrial Tachycardia using paced activation sequence mappingJournal of the American College of Cardiology, 1993Co-Authors: Cynthia M Tracy, Allen J Solomon, John F Swartz, Ross D Fletcher, Harry G HoopsAbstract:
Abstract Objectives . Although ectopic Atrial Tachycardia is infrequent, it can be an important clinical challenge. We sought to define an alternative therapeutic approach to this refractory problem. Background . Radiofrequency energy catheter ablation has been used to treat a variety of ventricular and supraventricular arrhythmias but has not been proved afficacious in the management of ectopic Atrial Tachycardia. Methods . Ten patients (14 to 47 years of age) referred with refractory ectopic Atrial Tachycardia were studied. Mapping techniques included identification of earliest Atrial activation, confirmation of concordance of P wave configuration during spontaneous Tachycardia and pacing from the ablation catheter, and paced activation sequence mapping. The paced activation sequence mapping compared the activation sequence at multiple Atrial sites during spontaneous Tachycardia with that recorded during pacing from the ablation catheter. The catheter was steered to a point where pacing reproduced the spontaneous activation sequence. Results . Foci were right Atrial in eight patients and left Atrial in two. In 8 of 10 patients, 514 ± 97 (SE) J and 5.7 ± 2.3 (SD) J radiofrequency energy applications ablated the ectopic focus. Seven of these eight patients presented with one focus and one had two discrete and stable foci. Ablation was unsuccessful in two patients with multiple foci. No complications occurred. An arrhythmia focus recurred in two patients and one patient underwent successful repeat ablation. The other patient was managed medically. All seven patients with successful ablation are symptom free after (6.5 ± 3.8 months. Conclusions . Our preliminary experience suggests that with the use of both paced activation sequence mapping and standard techniques, radiofrequency ablation of ectopic Atrial Tachycardia may be a safe and effective form of therapy.
Fred Morady – 2nd expert on this subject based on the ideXlab platform
diagnosis and ablation of atypical Atrial Tachycardia and flutter complicating Atrial fibrillation ablationHeart Rhythm, 2009Co-Authors: Fred Morady, Hakan Oral, Aman ChughAbstract:
Depending on the ablation strategy, up to 30% to 50% of patients will develop an Atrial Tachycardia after undergoing radiofrequency catheter ablation of Atrial fibrillation. This review discusses the mechanisms, mapping techniques, and catheter ablation of Atrial Tachycardias that occur after radiofrequency ablation of Atrial fibrillation.
A technique for the rapid diagnosis of Atrial Tachycardia in the electrophysiology laboratoryJournal of the American College of Cardiology, 1999Co-Authors: Bradley P. Knight, Adam Zivin, Joseph Souza, Matthew Flemming, Frank Pelosi, Rajiva Goyal, K. Ching Man, S. Adam Strickberger, Fred MoradyAbstract:
OBJECTIVE: The purpose of this study was to determine if the Atrial response upon cessation of ventricular pacing associated with 1:1 ventriculoAtrial conduction during paroxysmal supraventricular Tachycardia is a useful diagnostic maneuver in the electrophysiology laboratory. BACKGROUND: Despite various maneuvers, it can be difficult to differentiate Atrial Tachycardia from other forms of paroxysmal supraventricular Tachycardia. METHODS: The response upon cessation of ventricular pacing associated with 1:1 ventriculoAtrial conduction was studied during four types of Tachycardia: 1) atrioventricular nodal reentry (n = 102), 2) orthodromic reciprocating Tachycardia (n = 43), 3) Atrial Tachycardia (n = 19) and 4) Atrial Tachycardia simulated by demand Atrial pacing in patients with inducible atrioventricular nodal reentry or orthodromic reciprocating Tachycardia (n = 32). The electrogram sequence upon cessation of ventricular pacing was, categorized as ‘Atrialventricular’ (A-V) or ‘Atrial–Atrial-ventricular’ (A-A- V). RESULTS: The A-V response was observed in all cases of atrioventricular nodal reentrant and orthodromic reciprocating Tachycardia. In contrast, the A-A-V response was observed in all cases of Atrial Tachycardia and simulated Atrial Tachycardia, even in the presence of dual atrioventricular nodal pathways or a concealed accessory atrioventricular pathway. CONCLUSIONS: In conclusion, an A-A-V response upon cessation of ventricular pacing associated with 1:1 ventriculoAtrial conduction is highly sensitive and specific for the identification of Atrial Tachycardia in the electrophysiology laboratory.
W U Delon – 3rd expert on this subject based on the ideXlab platform
atypical atrioventricular nodal reentry Tachycardia with atrioventricular block mimicking Atrial Tachycardia electrophysiologic properties and radiofrequency ablation therapyJournal of Cardiovascular Electrophysiology, 1997Co-Authors: Yasuhiro Taniguchi, Chunchieh Wang, W U DelonAbstract:
AVNRT Mimicking Atrial Tachycardia, Introduction: Fast-intermediate form AV nodal reentry Tachycardia (AVNRT) sometimes may mimic Atrial Tachycardia or Atrial flutter and render the diagnosis difficult when the Tachycardia rate is fast and AV block occurs during Tachycardia.
Methods and Results: A 45-year-old woman with paroxysmal supraventricular Tachycardia was referred to this institution. Initially, the Tachycardia was thought to be an Atrial Tachycardia because of: (1) a short cycle length of the Tachycardia with 2:1 and Wenckebach AV block; (2) a difference in the Atrial activation sequence during Tachycardia and during ventricular pacing; and (3) failure of burst ventricular pacing to affect the Atrial rate and the Atrial activation sequence during Tachycardia. An accurate diagnosis of fast-intermediate form AVNRT was subsequently made based on the finding that the Tachycardia was induced following delivery of a third ventricular extrastimulus, which showed a sequence of V-A-H and a change on Atrial activation sequence of the induced beat. Successful radiofrequency ablation was achieved only after accurate diagnosis of the Tachycardia was made.
Conclusion: Fast-intermediate form AVNRT sometimes may masquerade as Atrial Tachycardia. Accurate diagnosis is mandatory for successful ablation therapy.