Atrial Tachycardias Arising from the Atrial Appendages and Aortic Sinus of Valsalva

Author(s): Colleen M. Taylor , Himabindu Samardhi , Haris M. Haqqani .

Journal Name: Current Cardiology Reviews

Volume 11 , Issue 2 , 2015

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Abstract:

Focal atrial tachycardias arising from the atrial appendages and the aortic sinuses of Valsalva are less frequently encountered in clinical practice. This review article describes the clinical presentation, surface P wave morphology, electrophysiologic characteristics and treatment of these arrhythmias. Catheter ablation of these focal tachycardias has a high success rate. It is however important to be aware of specific anatomic considerations in these locations for optimal treatment outcomes with low complication rates.

Keywords: Ablation, aortic sinus of Valsalva, atrial appendage, atrial tachycardia, non-coronary cusp.

[1]
Kalman JM, Olgin JE, Karch MR, Hamdan M, Lee RJ, Lesh MD. “Cristal tachycardias”: Origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography. J Am Coll Cardiol 1998; 31(2): 451-9.
[2]
Morton JB, Sanders P, Das A, Vohra JK, Sparks PB, Kalman JM. Focal atrial tachycardia arising from the tricuspid annulus: Electrophysiologic and electrocardiographic characteristics. J Cardiovasc Electr 2001; 12(6): 653-9.
[3]
Kistler PM, Fynn SP, Haqqani H, et al. Focal atrial tachycardia from the ostium of the coronary sinus: Electrocardiographic and electrophysiological characterization and radiofrequency ablation. J Am Coll Cardiol 2005; 45(9): 1488-93.
[4]
Kistler PM, Sanders P, Fynn SP, et al. Electrophysiological and electrocardiographic characteristics of focal atrial tachycardia originating from the pulmonary veins: Acute and long-term outcomes of radiofrequency ablation. Circulation 2003; 108(16): 1968-75.
[5]
Kistler PM, Sanders P, Hussin A, et al. Focal atrial tachycardia arising from the mitral annulus: Electrocardiographic and electrophysiologic characterization. J Am Coll Cardiol 2003; 41(12): 2212-9.
[6]
Iwai S, Badhwar N, Markowitz SM, et al. Electrophysiologic properties of para-hisian atrial tachycardia. Heart Rhythm 2011; 8(8): 1245-53.
[7]
Chen CC, Tai CT, Chiang CE, et al. Atrial tachycardias originating from the atrial septum: Electrophysiologic characteristics and radiofrequency ablation. J Cardiovasc Electr 2000; 11(7): 744-9.
[8]
Marrouche NF. SippensGroenewegen A, Yang Y, Dibs S, Scheinman MM. Clinical and electrophysiologic characteristics of left septal atrial tachycardia. J Am Coll Cardiol 2002; 40(6): 1133-9.
[9]
Wong MC, Kalman JM, Ling LH, et al. Left septal atrial tachycardias: Electrocardiographic and electrophysiologic characterization of a paraseptal focus. J Cardiovasc Electr 2013; 24(4): 413-8.
[10]
Tang CW, Scheinman MM, Van Hare GF, et al. Use of p wave configuration during atrial tachycardia to predict site of origin. J Am Coll Cardiol 1995; 26(5): 1315-24.
[11]
Roberts-Thomson KC, Kistler PM, Haqqani HM, et al. Focal atrial tachycardias arising from the right atrial appendage: Electrocardiographic and electrophysiologic characteristics and radiofrequency ablation. J Cardiovasc Electr 2007; 18(4): 367-72.
[12]
Wang YL, Li XB, Quan X, et al. Focal atrial tachycardia originating from the left atrial appendage: Electrocardiographic and electrophysiologic characterization and long-term outcomes of radiofrequency ablation. J Cardiovasc Electr 2007; 18(5): 459-64.
[13]
Yamada T, Murakami Y, Yoshida Y, et al. Electrophysiologic and electrocardiographic characteristics and radiofrequency catheter ablation of focal atrial tachycardia originating from the left atrial appendage. Heart Rhythm 2007; 4(10): 1284-91.
[14]
Freixa X, Berruezo A, Mont L, et al. Characterization of focal right atrial appendage tachycardia. Europace 2008; 10(1): 105-9.
[15]
Yang Q, Ma J, Zhang S, Hu JQ, Liao ZL. Focal atrial tachycardia originating from the distal portion of the left atrial appendage: Characteristics and long-term outcomes of radiofrequency ablation. Europace 2012; 14(2): 254-60.
[16]
Liu X, Dong J, Ho SY, et al. Atrial tachycardia arising adjacent to noncoronary aortic sinus: Distinctive atrial activation patterns and anatomic insights. J Am Coll Cardiol 2010; 56(10): 796-804.
[17]
Das S, Neuzil P, Albert CM, et al. Catheter ablation of peri-av nodal atrial tachycardia from the noncoronary cusp of the aortic valve. J Cardiovasc Electr 2008; 19(3): 231-7.
[18]
Ouyang F, Ma J, Ho SY, et al. Focal atrial tachycardia originating from the non-coronary aortic sinus: Electrophysiological characteristics and catheter ablation. J Am Coll Cardiol 2006; 48(1): 122-31.
[19]
Rillig A, Meyerfeldt U, Birkemeyer R, et al. Catheter ablation within the sinus of valsalva--a safe and effective approach for treatment of atrial and ventricular tachycardias. Heart Rhythm 2008; 5(9): 1265-72.
[20]
Medi C, Kalman JM, Haqqani H, et al. Tachycardia-mediated cardiomyopathy secondary to focal atrial tachycardia: Long-term outcome after catheter ablation. J Am Coll Cardiol 2009; 53(19): 1791-7.
[21]
Nagai T, Higaki J, Okayama H. Cardiovascular flashlight. Atrial tachycardia in congenital left atrial appendage aneurysm: Three-dimensional computed tomography imaging with electro-anatomical mapping. Eur Heart J 2010; 31(13): 1590.
[22]
Chen SA, Chiang CE, Yang CJ, et al. Sustained atrial tachycardia in adult patients. Electrophysiological characteristics, pharmacological response, possible mechanisms, and effects of radiofrequency ablation. Circulation 1994; 90(3): 1262-78.
[23]
Iwa T, Ichihashi T, Hashizume Y, Ishida K, Okada R. Successful surgical treatment of left atrial tachycardia. Am Heart J 1985; 109(1): 160-2.
[24]
Roberts-Thomson KC, Kistler PM, Kalman JM. Focal atrial tachycardia ii: Management. Pacing Clin Electrophysiol 2006; 29(7): 769-78.
[25]
Kistler PM, Roberts-Thomson KC, Haqqani HM, et al. P-wave morphology in focal atrial tachycardia: Development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol 2006; 48(5): 1010-7.
[26]
Pandozi C, Galeazzi M, Lavalle C, Ficili S, Russo M, Santini M. Navx-guided cryoablation of atrial tachycardia inside the left atrial appendage. Indian Pacing Electrophysiol J 2011; 10(12): 556-61.
[27]
Raczka F, Granier M, Mathevet L, Davy JM. Radiofrequency ablation of a left appendage focal tachycardia using intracardiac ultrasound image integration to guide catheter: Minimizing the risk of left appendage perforation. Europace 2009; 11(9): 1253-4.
[28]
Phillips KP, Natale A, Sterba R, et al. Percutaneous pericardial instrumentation for catheter ablation of focal atrial tachycardias arising from the left atrial appendage. J Cardiovasc Electr 2008; 19(4): 430-3.
[29]
Yamada T, McElderry HT, Allison JS, Kay GN. Focal atrial tachycardia originating from the epicardial left atrial appendage. Heart Rhythm 2008; 5(5): 766-7.
[30]
Chun KJ, Ouyang F, Schmidt B, Kuck KH. Focal atrial tachycardia originating from the right atrial appendage: First successful cryoballoon isolation. J Cardiovasc Electr 2009; 20(3): 338-41.
[31]
McGarvey JR, Schwartzman D, Ota T, Zenati MA. Minimally invasive epicardial left atrial ablation and appendectomy for refractory atrial tachycardia. Ann Thorac Surg 2008; 86(4): 1375-7.
[32]
Benussi S, Mazzone P, Maccabelli G, et al. Thoracoscopic appendage exclusion with an atriclip device as a solo treatment for focal atrial tachycardia. Circulation 2011; 123(14): 1575-8.
[33]
Wang Z, Liu T, Shehata M, et al. Electrophysiological characteristics of focal atrial tachycardia surrounding the aortic coronary cusps. Circ Arrhythm Electrophysiol 2011; 4(6): 902-8.
[34]
Kistler PM, Kalman JM. Locating focal atrial tachycardias from p-wave morphology. Heart Rhythm 2005; 2(5): 561-4.
[35]
Frey B, Kreiner G, Gwechenberger M, Gossinger HD. Ablation of atrial tachycardia originating from the vicinity of the atrioventricular node: Significance of mapping both sides of the interatrial septum. J Am Coll Cardiol 2001; 38(2): 394-400.
[36]
Jongbloed MR, Schalij MJ, Poelmann RE, et al. Embryonic conduction tissue: A spatial correlation with adult arrhythmogenic areas. J Cardiovasc Electr 2004; 15(3): 349-55.
[37]
Gonzalez MD, Contreras LJ, Jongbloed MR, et al. Left atrial tachycardia originating from the mitral annulus-aorta junction. Circulation 2004; 110(20): 3187-92.
[38]
Raatikainen MJ, Huikuri HV. Successful catheter ablation of focal atrial tachycardia from the non-coronary aortic cusp. Europace 2007; 9(4): 216-9.
[39]
Mlcochova H, Wichterle D, Peichl P, Kautzner J. Catheter ablation of focal atrial tachycardia from the aortic cusp: The role of electroanatomic mapping and intracardiac echocardiography. Pacing Clin Electrophysiol 2013; 36(1): e19-22.
[40]
d’Avila A, Thiagalingam A, Holmvang G, Houghtaling C, Ruskin JN, Reddy VY. What is the most appropriate energy source for aortic cusp ablation? A comparison of standard rf, cooled-tip rf and cryothermal ablation. J Interv Card Electrophysiol 2006; 16(1): 31-8.
[41]
Pons M, Beck L, Leclercq F, Ferriere M, Albat B, Davy JM. Chronic left main coronary artery occlusion: A complication of radiofrequency ablation of idiopathic left ventricular tachycardia. Pacing Clin Electrophysiol 1997; 20(7): 1874-6.


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Article Details

VOLUME: 11
ISSUE: 2
Year: 2015
Page: [118 - 126]
Pages: 9
DOI: 10.2174/1573403X10666141013121631
Price: $58

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