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Focal Atrial Tachycardia Arising from the Tricuspid Annulus: Electrophysiologic and Electrocardiographic Characteristics
Author(s) -
MORTON JOSEPH B.,
SANDERS PRASHANTHAN,
DAS ARVIND,
VOHRA JITENDRA K.,
SPARKS PAUL B.,
KALMAN JONATHAN M.
Publication year - 2001
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2001.00653.x
Subject(s) - medicine , crista terminalis , tachycardia , ablation , cardiology , radiofrequency ablation , coronary sinus , atrial tachycardia , catheter ablation
Tricuspid Annular Tachycardia.Introduction: Focal right atrial tachycardia (RAT) arising from the crista terminalis, para‐Hisian, and coronary sinus os regions are well described. Less information exists regarding RAT arising from the nonseptal region of the tricuspid annulus (TA). Methods and Results: From a consecutive series of 64 patients who had undergone successful radiofrequency ablation (RFA) of 67 RATs, the characteristics of 9 (13%) patients ( 6 men; mean age 50 ± 20 years ) with a TA focus were reviewed. The annular focus was localized to the inferoanterior TA in 7 and the superior TA in 2. Mean tachycardia cycle length was 371 ± 66 msec . Mean activation time at the site of successful RFA in 9 of 9 patients was −43 ± 11 msec . At 9.3 ± 5.6 months of follow‐up, 1 of 9 patients had recurrent tachycardia successfully treated with repeat RFA. In 7 of 9 patients with RAT from the inferoanterior TA, the surface ECG P wave morphology was upright in aVL, inverted in III and V 1 , and either inverted or biphasic with an initial negative deflection from V 2 to V 6 . Conclusion: The TA is an important site of origin of RAT. In the present study, the inferoanterior region of the TA was a preferential site of origin with resulting characteristic P wave morphology. Knowledge of this anatomic distribution and P wave morphology allows targeted mapping and may facilitate successful RFA.