Atrial Tachycardia Originating from a Single Site with Exit Block Mimicking Atrial Fibrillation Eliminated with Radiofrequency Applications

Mecca, Andrew; Guo, Hongsheng; Telfer, Andrew; Olshansky, Brian

doi:10.1111/j.1540-8167.1998.tb00887.x

Cited by 15 publications

(13 citation statements)

References 9 publications

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“…As we have known, it has been demonstrated that AF could be initiated by ectopic beats, and successful ablation of the ectopic foci could cure AF. [4][5][6][7][8][9] This new concept of AF mechanism is the onset mechanism of AF. [4][5][6][7][8][9][10] In the present study, all the patients had spontaneous AF onset initiated by the ectopic beats, and all the episodes of spontaneous transition from typical atrial flutter to AF were initiated by the same ectopic foci.…”

Section: Possible Mechanisms Of Spontaneous Transition From Typical Amentioning

confidence: 99%

“…[1][2][3] Recently, it has been demonstrated that paroxysmal AF could be initiated by a rapid firing focus; most of the ectopic foci originated from the pulmonary veins (PVs) or the crista terminalis, and they could be eliminated by radiofrequency catheter ablation. [4][5][6][7][8][9] This interesting finding led to new insights of AF mechanisms; the mechanisms may include the onset mechanism of AF from ec-topic foci, and the maintenance mechanism of AF by multiple wavelets. 4,5, [9][10][11] Furthermore, this important finding also provided a new consideration about the mechanism of spontaneous transition from atrial flutter to AF.…”

Section: Introductionmentioning

confidence: 99%

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Mechanism of Spontaneous Transition from Typical Atrial Flutter to Atrial Fibrillation: Role of Ectopic Atrial Fibrillation Foci

Hsieh

Tai

Tsai

et al. 2001

Pacing Clinical Electrophis

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Paroxysmal AF has been known to be initiated by ectopic beats, especially in the pulmonary veins (PVs), and radiofrequency catheter ablation could cure it. We considered that the spontaneous transition from typical atrial flutter to AF also could be initiated by ectopic beats. Twenty patients (18 men, mean age 66 +/- 14 years) with episodes of spontaneous transition from typical atrial flutter to AF were included in this study. They underwent detailed mapping of both atria. All the patients had spontaneous AF initiated by ectopic beats, and all of them had typical atrial flutter and spontaneous transition from typical atrial flutter (12 patients with counterclockwise atrial flutter and 8 patients with clockwise atrial flutter) to AF. The transition was initiated by ectopic beats from the PVs (17 foci, 85%), crista terminalis (2 foci, 10%), and superior vena cava (1 focus, 5%). After successful ablation of AF foci, typical atrial flutter was induced again, but no spontaneous transition was found after at least 10 minutes of observation. We concluded that paroxysmal AF and spontaneous transition from typical atrial flutter to AF were initiated by ectopic beats, and successful catheter ablation of the ectopic foci can eliminate paroxysmal AF and spontaneous transition from typical atrial flutter to AF.

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Section: Possible Mechanisms Of Spontaneous Transition From Typical Amentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mechanism of Spontaneous Transition from Typical Atrial Flutter to Atrial Fibrillation: Role of Ectopic Atrial Fibrillation Foci

Hsieh

Tai

Tsai

et al. 2001

Pacing Clinical Electrophis

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“…A very fast focal discharge with variable exit block from the arrhythmogenic focus or nonuniform centrifugal spreads from the focus with a fibrillatory conduction pattern in the reminder atria can rise to the electrocardiographic pattern of atrial fibrillation. 52) Endocardial Activation Sequential Mapping First, endocardial activation mapping starts with routine catheters positions, such as the high right atrium, coronary sinus and His-bundle region for estimation of the AT focus based on the atrial activation pattern. Second, further detailed mapping is performed by an ablation catheter positioned around the region of interest to identify the earliest activation timing relative to the P-wave onset or atrial electrogram deflection recorded from electrodes at the fixed positions such as the coronary sinus ostium or high right atrium.…”

Section: -Lead Surface Ecgmentioning

confidence: 99%

Focal Atrial Tachycardia

Higa

Chen

2006

J Arrhythmia

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Over the past decade, most of the electrophysiologic mechanisms in patients with focal atrial tachycardias (ATs) have been well studied. Recently, advanced mapping systems have revealed the precise propagation, and the relationship between non-radial propagation pattern and substrate property of focal AT. Non-radial activation pattern of focal AT may mimic macrorentrant AT and may lead to inappropriate ablation strategy. In this review, we will focus on the current state of mapping and ablation techniques, safety, and efficacy associated with the catheter ablation for focal AT. (J Arrhythmia 2006; 22: 132-148)

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“…In 1975, Wu et al [1] reported a case of left AT with separation of the left and right atrial components of the P wave; the surface electrocardiogram resembled that of atrial flutter. Mecca et al [2] reported a case of a patient with a right AT and atrial fibrillation in whom a single site was found responsible for both conditions. In 2000, Ino et al [3] described focal repetitive activity within the superior vena cava at a CL of 120-175 ms and 2:1 exit block to the atria masquerading as the atrial activation observed with high right atrial AT.…”

Section: Case Reportmentioning

confidence: 99%

mentioning

confidence: 99%

Right atrial tachycardia with 2:1 intra‐atrial conduction

Kofune

Watanabe

Okumura

2014

Journal of Arrhythmia

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a b s t r a c tIn a case of atrial tachycardia (AT) originating from the inferolateral right atrium, cycle length (CL) alternans was observed. Conduction at the longer CL was to the high right atrium (HRA), His bundle electrogram region (HBE), and coronary sinus (CS). Conduction at the shorter CL was to the HRA, with that to the HBE and CS blocked.& 2014 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved. Case reportA 54-year-old woman presented to our clinic with palpitation and shortness of breath. Six years previously, she underwent successful catheter ablation for focal atrial tachycardia (AT) originating from the base of the right atrial appendage and right side of the fossa ovalis. However, AT originating from the inferolateral right atrium (RA) could not be ablated. The patient later developed multiple sclerosis, and steroid therapy was started. However, the AT recurred 2 months after the initiation of steroid therapy. Catheter ablation was again performed. The RA voltage map during sinus rhythm (Fig. 1, left) revealed a low-voltage area in the inferolateral RA and scarring at the inferolateral RA adjacent to the tricuspid annulus. Focal AT (AT1; tachycardia cycle length [CL]: 442 ms, total right atrial activation time: 23 ms) at 136 beats/min that originated from the inferolateral RA adjacent and anterior to the scar (Figs. 1 and 2, right) was induced by programmed atrial pacing and successfully ablated. Programmed atrial stimulation was performed to confirm the success of the ablation, but AT was easily induced by rapid atrial pacing, and the site of the earliest site was shifted to the lateral side along the right atrial scar area. Additional ablation was performed at the earliest activation site. Therefore, ablation points formed a linear ablation line along the right atrial scar site. Finally, another focal AT (AT2) was induced. The earliest AT2 activation site (hereafter referred to as the ABL site) was located lateral to the AT1 site (Fig. 3), and the AT2 was characterized by the presence of slight CL alternans (Fig. 4). The AT2 of the longer CL (184 and 182 ms) was conducted to the high right atrium (HRA), His bundle electrogram (HBE) region, and proximal and distal coronary sinuses (CSp and CSd, respectively). However, the AT2 of the shorter CL (167 and 174 ms) was conducted to the HRA, but conduction to the HBE and CS was blocked. The reason that the AT2 conducted to the RA appendage (HRA) but showed 2:1 conduction to the HBE region and left atrium might be explained as follows: the multiple ablation points actually created the linear lesion formation from the anterolateral tricuspid annulus to the inferolateral right atrium (Fig. 3) along the scar area (Fig. 1, left); thus, the activated AT2 could not conduct to the septal RA and LA in a 1:1 fashion. The surface electrocardiogram obtained during AT2 showed fairly regular results but no obvious P wave, which is typical of atrial fibrillation. AT2 was seen during the point-by-point ablation of the re-induced AT; therefo...

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Atrial Tachycardia Originating from a Single Site with Exit Block Mimicking Atrial Fibrillation Eliminated with Radiofrequency Applications

Abstract: We describe the case of a patient who has a right atrial tachycardia and atrial fibrillation who was found to have a single site responsible for both. We recorded a tachycardia from this site with exit block into the remainder of the atria.

Cited by 15 publications

References 9 publications

Mechanism of Spontaneous Transition from Typical Atrial Flutter to Atrial Fibrillation: Role of Ectopic Atrial Fibrillation Foci

Mechanism of Spontaneous Transition from Typical Atrial Flutter to Atrial Fibrillation: Role of Ectopic Atrial Fibrillation Foci

Focal Atrial Tachycardia

Right atrial tachycardia with 2:1 intra‐atrial conduction

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