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Series case report of efficacy and safety of radiofrequency catheter ablation to treat atrial tachycardia originating from the distal portion of the atrial appendage
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Objective: Our case series report aims to investigate the efficacy and safety of radiofrequency catheter ablation (RFCA) to terminate atrial tachycardia (AT) originating from the distal portion of the atrial appendage.
Material and methods: Three-dimensional electroanatomic mapping (3-DEAM) systems (CARTO and Ensite Precision) were used in our study in two cases to create map and assess the anatomic location. Clinical features and electrocardiographic (ECG) characteristics were analyzed. We perform our ablations by using a infusing -cold saline and contact force sensing catheter at the appendages targeting loci of atrial tachycardia (AT) origin under the guidance of the 3-DEAM system. The curative effect and safe were evaluated.
Results: The ages of the two patients were 23 and 61 years old. With case 1, we found that the AT origin was from the right atrial appendage (RAA) and with case 2, we found that the AT origin was from the left atrial appendage (LAA). The ECG characteristics of AT from the RAA were as follows: (1) negative P waves in chest leads V1,V2; (2) positive P waves in peripheral leads II, III, aVF, D1, aVL. The ECG of the AT originated from LAA was characterized by: (1) positive P waves in chest leads V1,V2 and in inferior leads II, III, aVF but the P wave is obscured within the T wave. (2) P waves are isoelectric in leads DI; and (3) P waves are negative in lead aVL. Pre-operation echocardiography showed normal left ventricular ejection fraction (LVEF) and no thrombus in both cases. Radiofrequency ablation was successful in both patients. The earliest activation time of the successful RFA sites(the endpoint sites) was 34ms and 43ms before the onset of the P wave. There were no complications and long-term success was achieved in both patients during follow-up 23,5 months.
Conclusions: We prove that the atrial tachycardia which origin was from the atrial appendages showed the characteristic P-wave manifestations on ECG and RFCA to treat AT originating from the distal portion of the atrial appendage was safe and effective during follow-up average 23,5 months.
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Từ khóa
Case report, atrial tachycardia, atrial appendage, radiofrequency catheter ablation, distal of the atrial appendage
Tài liệu tham khảo
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