Gwilym M Morris1, Louise Segan2, Geoff Wong2, Gareth Wynn2, Troy Watts2, Patrick Heck2, Tomos E Walters2, Ashley Nisbet2, Paul Sparks2, Joseph B Morton2, Peter M Kistler3, Jonathan M Kalman4. 1. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom. 2. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. 3. Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Australia. 4. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia. Electronic address: jon.kalman@mh.org.au.
Abstract
OBJECTIVES: The goal of this study was to characterize, in detail, focal atrial tachycardia (AT) arising from the crista terminalis to investigate associations with other atrial arrhythmia and to define long-term ablation outcomes. BACKGROUND: The crista terminalis is known to be the most common site of origin for focal AT, but it is not well characterized. METHODS: This study retrospectively identified a total of 548 ablation procedures for AT performed at a single center over a 16-year period, of which 171 were arising from the crista terminalis. RESULTS: Compared with patients with other AT sites of origin, crista terminalis AT patients were older (57.3 vs. 47.3 years), more commonly female (72.9% vs. 59.1%), were more commonly associated with coexistent atrioventricular nodal re-entry tachycardia (17.1% vs. 9.7%), and were more likely to be inducible with programmed stimulation (81.5% vs. 58.9%). There was preferential conduction in the superior-inferior axis along the crista terminalis. Acute ablation success rate was high (92.2%) and improved significantly when three-dimensional mapping was used (98.5%). Recurrence in the first 12 months after a successful ablation was 9.7%. Only 2 patients developed atrial fibrillation over the long-term follow-up of >7 years. CONCLUSIONS: This large series characterized the clinical and electrophysiological features and immediate and long-term ablation outcomes for AT originating from the crista terminalis. Features of the tachycardia suggest that age-related localized remodeling of the crista terminalis causes a superficial endocardial zone of conduction slowing leading to re-entry. Ablation outcomes were good, with long-term freedom from atrial arrhythmia.
OBJECTIVES: The goal of this study was to characterize, in detail, focal atrial tachycardia (AT) arising from the crista terminalis to investigate associations with other atrial arrhythmia and to define long-term ablation outcomes. BACKGROUND: The crista terminalis is known to be the most common site of origin for focal AT, but it is not well characterized. METHODS: This study retrospectively identified a total of 548 ablation procedures for AT performed at a single center over a 16-year period, of which 171 were arising from the crista terminalis. RESULTS: Compared with patients with other AT sites of origin, crista terminalis AT patients were older (57.3 vs. 47.3 years), more commonly female (72.9% vs. 59.1%), were more commonly associated with coexistent atrioventricular nodal re-entry tachycardia (17.1% vs. 9.7%), and were more likely to be inducible with programmed stimulation (81.5% vs. 58.9%). There was preferential conduction in the superior-inferior axis along the crista terminalis. Acute ablation success rate was high (92.2%) and improved significantly when three-dimensional mapping was used (98.5%). Recurrence in the first 12 months after a successful ablation was 9.7%. Only 2 patients developed atrial fibrillation over the long-term follow-up of >7 years. CONCLUSIONS: This large series characterized the clinical and electrophysiological features and immediate and long-term ablation outcomes for AT originating from the crista terminalis. Features of the tachycardia suggest that age-related localized remodeling of the crista terminalis causes a superficial endocardial zone of conduction slowing leading to re-entry. Ablation outcomes were good, with long-term freedom from atrial arrhythmia.
Authors: Luca Soattin; Zoltan Borbas; Jane Caldwell; Brian Prendergast; Akbar Vohra; Yawer Saeed; Andreas Hoschtitzky; Joseph Yanni; Andrew Atkinson; Sunil Jit Logantha; Balint Borbas; Clifford Garratt; Gwilym Matthew Morris; Halina Dobrzynski Journal: Front Physiol Date: 2021-03-04 Impact factor: 4.566