Macroreentrant Atrial Tachycardia in Patients without Previous Atrial Surgery or Catheter Ablation: Clinical and Electrophysiological Characteristics of Scar-Related Left Atrial Anterior Wall Reentry

Scar‐Related Left Atrial Anterior Wall Reentry. Introduction: Macroreentrant atrial tachycardia (MRAT) has been described most frequently in patients with prior cardiac surgery. Left atrial tachycardia and flutter are common in patients who undergo atrial fibrillation ablation; however, few reports...

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Published in:Journal of cardiovascular electrophysiology 2013-04, Vol.24 (4), p.404-412
Main Authors: FUKAMIZU, SEIJI, SAKURADA, HARUMIZU, HAYASHI, TAKEKUNI, HOJO, RINTARO, KOMIYAMA, KOTA, TANABE, YASUHIRO, TEJIMA, TAMOTSU, NISHIZAKI, MITSUHIRO, KOBAYASHI, YOUICHI, HIRAOKA, MASAYASU
Format: Article
Language:English
Subjects:
Action Potentials
Aged
Aged, 80 and over
atrial arrhythmias
atrial tachycardia
Cardiac arrhythmia
cardiac mapping
Catheter Ablation
Catheters
Cicatrix - etiology
Cicatrix - pathology
Cicatrix - physiopathology
Electrocardiography
Electrophysiologic Techniques, Cardiac
entrainment
Feasibility Studies
Female
Heart Atria - pathology
Heart Atria - physiopathology
Heart Atria - surgery
Heart Conduction System - pathology
Heart Conduction System - physiopathology
Heart Conduction System - surgery
Heart surgery
Humans
left atrial flutter
macroreentry
Male
Predictive Value of Tests
Retrospective Studies
Risk Factors
Tachycardia, Supraventricular - diagnosis
Tachycardia, Supraventricular - etiology
Tachycardia, Supraventricular - physiopathology
Tachycardia, Supraventricular - surgery
Time Factors
Treatment Outcome
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Summary:Scar‐Related Left Atrial Anterior Wall Reentry. Introduction: Macroreentrant atrial tachycardia (MRAT) has been described most frequently in patients with prior cardiac surgery. Left atrial tachycardia and flutter are common in patients who undergo atrial fibrillation ablation; however, few reports describe left atrial MRAT involving the regions of spontaneous scarring. Here, we describe left atrial MRAT in patients without prior cardiac surgery or catheter ablation (CA) and discuss the clinical and electrophysiological characteristics of tachycardia and outcome of CA. Methods and Results: An electrophysiological study and CA were performed in 6 patients (3 men; age 76 ± 6 years) with MRAT originating from the left atrial anterior wall (LAAW). No patient had a history of cardiac surgery or CA in the left atrium. Spontaneous scars (areas with bipolar voltage ≤ 0.05 mV) were observed in all patients. The activation map showed a figure‐eight circuit with loops around the mitral annulus (4 counterclockwise and 2 clockwise) and a low‐voltage area with LAAW scarring. The mean tachycardia cycle length was 303 ± 49 milliseconds. The conduction velocity was significantly slower in the isthmus between the scar in the LAAW and the mitral annulus than in the lateral mitral annulus (0.17 ± 0.05 m/s vs 0.94 ± 0.35 m/s; P = 0.003). Successful ablation of the isthmus caused interruption of the tachycardia and rendered it noninducible in all patients. Conclusion: Spontaneous LAAW scarring is an unusual cause of MRAT, showing activation patterns with a figure‐eight configuration. Radiofrequency CA is a feasible and effective treatment in such cases. (J Cardiovasc Electrophysiol, Vol. 24, pp. 404‐412, April 2013)
ISSN:1045-3873
1540-8167
DOI:10.1111/jce.12059