Clinical, electrophysiological characteristics, and radiofrequency catheter ablation of atrial tachycardia near the apex of Koch's triangle
Journal
PACE - Pacing and Clinical Electrophysiology
Journal Volume
21
Journal Issue
2
Pages
367
Date Issued
1998
Author(s)
Abstract
Atrial tachycardia, with its focus near the apex of Koch's triangle, may carry a potential risk of atrioventricular block during radiofrequency catheter ablation. The efficacy and safety of this procedure have never been addressed. The characteristics and catheter ablation results are reported for six patients with atrial tachycardia near the apex of Koch's triangle. All six patients were female aged 49.6 ± 9.3 years (range 39-63). Organic heart disease was present in 3 (50%) of the 6 patients. The P wave in surface ECG had a mean axis of - 28°(range - 90°- + 30°) in the frontal plane. The catheter ablation was guided by activation sequence mapping. The energy was titrated from low power level. Atrial overdrive pacing was used to monitor the atrioventricular conduction should accelerated junctional rhythm occur. At the final successful ablation site, the local atrial activation was 41.8 ± 9.1 ms before the P wave and His-bundle potential was present in 5 of the 6 patients. All patients had their atrial tachycardia eliminated without recurrence or heart black during a follow-up period of 17.7 ± 8.5 months (range 6-30). In conclusion, atrial tachycardia near the apex of Koch's triangle has distinct clinical and electrophysiological features. Radiofrequency catheter ablation can be performed effectively. However, extreme care must be taken to prevent inadvertent atrioventricular block. Titrated energy application and continuous monitoring of atrioventricular conduction are mandatory.
Subjects
Atrial tachycardia; Catheter ablation; Koch's triangle
Other Subjects
adult; article; atrioventricular block; catheter ablation; clinical article; device; female; heart atrium pacing; his bundle potential; human; koch triangle; p wave; pacemaker electrode; radiofrequency; supraventricular tachycardia; surgical anatomy; Adult; Atrioventricular Node; Cardiac Pacing, Artificial; Catheter Ablation; Electrocardiography; Female; Heart Block; Humans; Middle Aged; Tachycardia, Ectopic Atrial
Type
journal article