Catheter ablation is a proven therapy of focal atrial tachycardia. However limited information is available about the additional value of electroanatomical over conventional mapping methods for this specific arrhythmia.
Consecutive catheter ablation procedures of FAT were analyzed in two cardiology centres. Only conventional mapping was used in 30 of the 60 procedures whereas additionally CARTO mapping was performed in another 30 procedures. Acute, six-month success rate, and procedural data were analyzed.
Localization of ectopic foci is congruent with previously published data. There was no statistically significant difference between procedure time and fluoroscopy time using additionally CARTO mapping, compared to conventional mapping only. Acute success rate was higher in procedures guided by CARTO mapping than in procedures based on conventional mapping (27/30 vs. 18/30, p = 0.0081). During the 6-month follow-up period there was a better outcome (p = 0.045) in case of CARTO guided procedures (success: 11 cases, partial success: 12 cases, failure: 4 cases) compared to conventional mapping (success: 4 cases, partial success: 18 cases, failure: 7 cases).
Catheter ablation of focal atrial tachycardias using the CARTO electroanatomical mapping system seems to provide higher acute and 6-month success rate compared to ablation using conventional mapping methods only.
Anguera I , Brugada J, Roba M, Mont L, Aguinaga L, Geelen P, Brugada P: Outcomes after radiofrequency catheter ablation of atrial tachycardia. Am. J. Cardiol. 87, 886–890 (2001)
Biviano AB , Bain W, Whang W, Leitner J, Dizon J, Hickey K, Garan H.: Focal left atrial Tachycardias not Associated with prior catheter ablation for atrial fibrillation: clinical and Electrophysiological characteristics. Pacing Clin. Electrophysiol. 35, 17–27 (2011)
Blomström-Lundqvist C , Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW Jr, Stevenson WG, Tomaselli GF, Antman EM, Smith SC Jr, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO Jr, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JC, Oto A, Smiseth O, Trappe HJ: ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary. Eur. Heart J. 24, 1857–1897 (2003)
Cavaco D , Adragão P, Morgado F, Aguiar C, Chotalal D, Palos J, Bonhorst D, Seabra-Comes R: Electroanatomical mapping and ablation of atrial tachycardias with the CARTO system. Rev. Port. Cardiol. 21, 407–418 (2002)
Femenía F , Arce M, Arrieta M, Baranchuk A: (Taquicardia auricular focal incesante originada en la orejuela derecha: riesgo de taquicardiomiopatía. Rol de la ablación por radiofrecuencia.) Incessant focal atrial tachycardia arising from the right appendage: risk of tachycardia mediated cardiomyopathy. Role of the radiofrequency ablation. Arch. Argent. Pediatr. 109, 33–38 (2011)
Furushima H , Chinushi M, Hosaka Y, Aizawa Y: Focal atrial tachycardia refractory to radiofrequency catheter ablation originating from right atrial appendage. Europace 11, 521–522 (2009).
González-Torrecilla E , Arenal Á, Quiles J, Atienza F, Jiménez-Candil J, del Castillo S, Almendral J: Nonfluoroscopic electroanatomical mapping (CARTO System) in the ablation of atrial tachycardias. Rev. Esp. Cardiol. 57, 37–44 (2004)
Gurevitz OT , Glikson M, Asirvatham S, Kester TA, Grice SK, Munger TM, Rea RF, Shen WK, Jahangir A, Packer DL, Hammill SC, Friedman PA: Use of advanced mapping systems to guide ablation in complex cases: experience with noncontact mapping and electroanatomic mapping systems. Pacing Clin. Electrophysiol. 28, 316–323 (2005)
Hindricks G : The Multicentre European Radiofrekvency Survey (MERFS): Complications of radiofrequency catheter ablation of arrhythmias. Eur. Heart J. 14, 1644–1653 (1993)
Hoffmann E , Reithmann C, Nimmermann P: Clinical experience with electroanatomic mapping of ectopic atrial tachycardia. Pacing Clin. Electrophysiol. 25, 49–56 (2002)
Huo Y , Braunschweig F, Gaspar T, Richter S, Schönbauer R, Sommer P, Arya A, Rolf S, Bollmann A, Hindricks G, Piorkowski C: Diagnosis of atrial tachycardias originating from the lower right atrium: importance of P-wave morphology in the precordial leads V3–V6. Europace. 4, 570–577 (2011)
Issa ZF , Miller JM, Zipes DP (2012): Focal atrial tachycardia. In: Clinical Arrhythmology and Electrophysiology. A companion to Braunwald’s Heart Disease, 2nd edition, Philadelphia, Saunders, pp. 212–237
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. 31, 451–459 (1998)
Kammeraad JAE , Balaji S, Oliver RP, Chugh SS, Halperin BD, Kron J, McAnulty JH: Nonautomatic focal atrial tachycardia: characterization and ablation of a poorly understood arrhythmia in 38 patients. Pacing Clin. Electrophysiol. 26, 736–742 (2003)
Lesh MD , Van Hare GF, Epstein LM, Fitzpatrick AP, Scheinman MM, Lee RJ, Kwasman MA, Grogin HR, Griffin JC: Radiofrequency catheter ablation of atrial arrhythmias: results and mechanisms. Circulation. 89, 1074–1089 (1994)
Natale A , Breeding L, Tomassoni G, Rajkovich K, Richey M, Beheiry S, Martinez K, Cromwell L, Wides B, Leonelli F: Ablation of right and left ectopic atrial tachycardias using a three-dimensional nonfluoroscopic mapping system. Am. J. Cardiol. 82, 989–992 (1998)
Packer DL : Three-dimensional mapping in interventional electrophysiology: techniques and technology. J. Cardiovasc. Electrophysiol. 16, 1110–1116 (2005)
Poty H , Saoudi N, Haissaguerre M, Daou A, Clémenty J, Letac B: Radiofrequency catheter ablation of atrial tachycardias. Am. Heart J. 131, 481–489 (1996)
Poutiainen AM , Koistinen MJ, Airaksinen KEJ, Hartikainen EK, Kettunen RVJ, Karjalainen JE, Huikuri HV: Prevalence and natural course of ectopic atrial tachycardia. Eur. Heart J. 20, 694–700 (1999)
Qian ZY , Hou XF, Xu DJ, Yang B, Chen ML, Chen C, Zhang FX, Shan QJ, Cao KJ, Zou JG: An algorithm to predict the site of origin of focal atrial tachycardia. Pacing Clin. Electrophysiol. 34, 414–421 (2011)
Reithmann C , Hoffmann E, Dorwarth U, Remp T, Steinbeck G: Electroanatomical mapping for visualization of atrial activation in patients with incisional atrial tachycardias. Eur. Heart J. 22, 237–246 (2001)
Roberts-Thomson KC , Kistler PM, Kalman JM: Focal atrial tachycardia I: clinical features, diagnosis, mechanisms, and anatomic location. Pacing Clin. Electrophysiol. 29, 643–652 (2006)
Roberts-Thomson KC , Kistler PM, Kalman JM: Focal atrial tachycardia II: management. Pacing Clin. Electrophysiol. 29, 769–778 (2006)
Rosso R , Kistler PM: Focal atrial tachycardia. Heart. 96, 181–185 (2006)
Schmitt H , Weber S, Schwab JO, Voss RM, Kneller R, Tillmanns H, Waldecker B: Diagnosis and ablation of focal right atrial tachycardia using a new high-resolution, non-contact mapping system. Am. J. Cardiol. 87, 1017–1021 (2001)
Steinbeck G , Hoffmann E: ‘True’ atrial tachycardia. Eur. Heart J. 19, E10–2, E48–9 (1998)
Teh AW , Kistler PM, Kalman JM: Using the 12-lead ECG to localize the origin of ventricular and atrial tachycardias: Part 1. Focal atrial tachycardia. J. Cardiovasc. Electrophysiol. 20, 706–709 (2009)
Toyohara K , Fukuhara H, Yoshimoto J, Ozaki N, Nakamura Y: Electrophysiologic studies and radiofrequency catheter ablation of ectopic atrial tachycardia in children. Pediatr. Cardiol. 32, 40–46 (2011)
Tracy CM , Swartz JF, Fletcher RD, Hoops HG, Solomon AJ, Karasik PE, Mukherjee D: Radiofrequency catheter ablation of ectopic atrial tachycardia using paced activation sequence mapping. J. Am. Coll. Cardiol. 21, 910–917 (1993)
Walsh EP , Saul JP, Hulse JE, Rhodes LA, Hordof AJ, Mayer JE, Lock JE: Transcatheter ablation of ectopic atrial tachycardia in young patients using radiofrequency current. Circulation. 86, 1138–1146 (1992)
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. 14, 254–260 (2012)
Zhou YF , Wang Y, Zeng YJ, Li XL, Zheng JG, Yang P, Zhao X, Liu XF, Gao YS, Zhang H, Peng WH: Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from noncoronary sinuses of Valsalva in the aorta. J. Interv. Card. Electrophysiol. 28, 147–151 (2010)