Circulation, Vol 90, 1262-1278, Copyright © 1994 by American Heart Association
SA Chen, CE Chiang, CJ Yang, CC Cheng, TJ Wu, SP Wang, BN Chiang and MS Chang
BACKGROUND: Mechanisms and electropharmacological characteristics in adult
patients with atrial tachycardia (AT) are not well described. We proposed
that a combination of electropharmacological characteristics, recording of
monophasic action potential, and effects of radiofrequency ablation could
further determine the mechanisms and achieve a new classification in adults
with various types of AT because they were important in regard to the
correlation between mechanisms and pathophysiology, clinical syndrome, and
responses to specific pharmacological or nonpharmacological therapies.
METHODS AND RESULTS: Thirty-six patients (11 female, 25 male; mean age, 57
+/- 13 years) with AT were referred for electropharmacological studies and
radiofrequency ablation. Resetting response pattern, entrainment
phenomenon, recording of monophasic action potential, serial drug test,
response to Valsalva maneuver, endocardial mapping technique, and
radiofrequency ablation were performed. Seven patients had automatic AT
provocable with isoproterenol; neither initiation nor termination was
related to programmed electrical stimulation. The other 29 patients had AT
initiated or terminated by electrical stimulation and mechanisms related to
triggered activity or reentry; nine of them needed isoproterenol to
facilitate initiation of AT, associated with delayed afterdepolarization in
monophasic action potential. All responded to adenosine (15 to 60
micrograms/kg) and Valsalva maneuver. Dipyridamole terminated AT and
decreased the slope of afterdepolarization. Afterdepolarization was not
found in the patients with automatic or reentrant AT. In 40 of 41 (98%), AT
was ablated successfully, with late recurrence in 2 of 40 (5%) (follow-up,
18 +/- 4 months). CONCLUSIONS: This study demonstrates the diverse
mechanisms and electropharmacological characteristics of AT in adults.
Furthermore, radiofrequency ablation of various types of AT could achieve
high success and low recurrence rates.
ARTICLES
Sustained atrial tachycardia in adult patients. Electrophysiological characteristics, pharmacological response, possible mechanisms, and effects of radiofrequency ablation
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC.
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