Diagnosis and surgical treatment of ectopic atrial tachycardia

Abstract

Eighty-two patients with ectopic atrial tachycardia (EAT) were subjected to radical closed heart surgery (without cardiopulmonary bypass). The age of the patients ranged from 1 to 51 years. Permanent EAT was present in 19 patients, incessant EAT in 14, and paroxysmal EAT in 49 patients. Preoperative electrophysiological study included computed analysis of the P wave vector. Ectopic foci were established in the right atrium in 34 patients, in the left atrium in 11, in the interatrial septum in 32, and extracardially in 5 patients. For ablation or isolation of the foci, the cryogenic technique was used in 74 patients, cryo- and laser techniques in 4, and the laser technique alone in 1 patient. In 3 patients resection of the atrial auricles including the ectopic focus was undertaken. In 4 patients complete AV block was induced and a cardiac pacemaker implanted. After primary surgery, favourable results were obtained in 71 patients. In 11 patients recurrences were observed; 8 of these patients underwent successful repeat surgery. In 3 patients medical treatment was effective. Finally, the follow-up results have been promising-79 patients (96.4%) (including 4 patients in whom a complete AV block was created) have become arrhythmia-free. When EAT is resistant to medical treatment, closed heart ablation of the ectopic focus has proved to be safe (no mortality or morbidity) and effective. It can therefore be recommended not only for the termination of EAT but also for the prevention of dilated cardiomyopathy.

Lower Incidence of Thrombus Formation With Cryoenergy Versus Radiofrequency Catheter Ablation

“…This provocative observation is consistent with different mechanisms of lesion formation, with a less clear relationship between cryoablation lesion size and extent of endothelial cell injury. A plausible clinically relevant corollary to this finding is that interventions requiring more extensive tissue destruction, such as procedures for 28 -32 In 118 patients undergoing surgical ablation of reentrant supraventricular arrhythmias 30 and 82 patients with ectopic atrial tachycardia, 31 no thromboembolic complications were reported. In a series of 14 patients undergoing the maze procedure for atrial fibrillation, 1 patient with Yamagushi disease had a small pulmonary embolus.…”

Surgery for Arrhythmias

“…Cryoablation of the ectopic focus, with or without cardiopulmonary bypass, is effective (Bredikis et al, 1991). However, it should be realized that epicardial cryoablation may not produce a transmural lesion in the normothermic beating heart (Doll et al, 2003).…”

“…A combination of cryoablation and resection might be effective in some cases (Graffigna et al, 1992). For multiple ectopic focal tachycardias, more extensive techniques could be required, such as right or left atrial isolation or pulmonary vein isolation (Bredikis et al, 1991;Doll et al, 2003).…”