Radiofrequency Ablation for Atrial Tachycardia and Atrial Flutter

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Presentation transcript:

Radiofrequency Ablation for Atrial Tachycardia and Atrial Flutter Tomos E. Walters, MBBS, Peter M. Kistler, PhD, Jonathan M. Kalman, PhD Heart, Lung and Circulation Volume 21, Issue 6, Pages 386-394 (June 2012) DOI: 10.1016/j.hlc.2012.02.001 Copyright © 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Terms and Conditions

Figure 1 (A) Surface ECG and endocardial recordings from a 20-electrode catheter during clockwise atrial flutter (left) and counterclockwise atrial flutter (right). There is continuous undulation of the baseline in the surface ECG leads consistent with continuous circus activation of atrial myocardium. This is reflected in endocardial activation recorded throughout large portions of the tachycardia cycle. (Reproduced with permission of the Journal of Cardiovascular Electrophysiology). (B) Surface ECG and endocardial recordings from a 20-electrode catheter during focal atrial tachycardia from the high crista terminalis (left) and during sinus rhythm (right). Atrial activation, reflected in the P-wave on the surface ECG and in the endocardial recordings, is confined to a limited portion of the tachycardia cycle. (Reproduced with permission of the Journal of the American College of Cardiology.) Heart, Lung and Circulation 2012 21, 386-394DOI: (10.1016/j.hlc.2012.02.001) Copyright © 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Terms and Conditions

Figure 2 Macro-reentry atrial tachycardia around regions of spontaneous scar in the right atrial free wall. (A) Electroanatomic voltage maps in 3 different patients demonstrating spontaneous scarring in the right atrial free wall, with the free wall shown en face. Scar is shown in grey and areas of low voltage in red. (B) Activation maps demonstrating tachycardia circuits around regions of scarring, with earliest activation in red and latest in purple. The upper panel demonstrates a clockwise tachycardia circuit around a scarred region, with subsequent successful ablation between the scar and the inferior vena cava. In the lower panel an anticlockwise tachycardia circuit initially passes through a channel between areas of scar and later, after ablation within this channel, passes between the scar and the inferior vena cava. Ablation at this point was successful in terminating the tachycardia. IVC, inferior vena cava; SVC, superior vena cava; TA, tricuspid annulus. Reproduced with permission of Heart Rhythm. Heart, Lung and Circulation 2012 21, 386-394DOI: (10.1016/j.hlc.2012.02.001) Copyright © 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Terms and Conditions

Figure 3 Focal atrial tachycardias. (A) Electroanatomic activation maps in the left anterior oblique (LAO) and right anterior oblique (RAO) projections demonstrating centrifugal spread of activation from a focus at the base of the right atrial appendage. The red dots mark the site of successful ablation at the site of earliest atrial activation. (B) Focal tachycardia from the aorto-mitral continuity. In the upper panel an activation map in the LAO projection demonstrates centrifugal spread from the focus of origin, with the successful ablation site at the site of earliest atrial activation marked with a red dot. In the lower panel a transoesophageal echocardiogram shows the ablation catheter tip (□) in contact with the aorto-mitral continuity at the successful ablation site. Ao, aorta; LA, left atrium; LAA, left atrial appendage; LSPV, left superior pulmonary vein; LV, left ventricle; MA, mitral annulus; MV, mitral valve; RSPV, right superior pulmonary vein; RV, right ventricle; TA, tricuspid annulus. Reproduced with permission of the Journal of Cardiovascular Electrophysiology. Heart, Lung and Circulation 2012 21, 386-394DOI: (10.1016/j.hlc.2012.02.001) Copyright © 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) Terms and Conditions