Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/39096
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Type: Journal article
Title: Focal atrial tachycardia arising from the mitral annulus: Electrocardiographic and electrophysiologic characterization
Author: Kistler, P.
Sanders, P.
Hussin, A.
Morton, J.
Vohra, J.
Sparks, P.
Kalman, J.
Citation: Journal of the American College of Cardiology, 2003; 41(12):2212-2219
Publisher: Elsevier Science Inc
Issue Date: 2003
ISSN: 0735-1097
1558-3597
Statement of
Responsibility: 
Peter M. Kistler, Prashanthan Sanders, Azlan Hussin, Joseph B. Morton, Jitendra K. Vohra, Paul B. Sparks and Jonathan M. Kalman
Abstract: OBJECTIVES:The study was done to characterize the electrocardiographic and electrophysiologic features of focal atrial tachycardia originating at the mitral annulus (MA). BACKGROUND:Though the majority of left atrial tachycardias originate around the ostia of the pulmonary veins, only isolated reports have described focal tachycardia originating from the MA. METHODS:Seven patients of a consecutive series of 172 patients undergoing radiofrequency ablation for focal atrial tachycardia are reported. Electrophysiologic study involved catheters positioned along the coronary sinus (CS), crista terminalis (CT), His bundle, and a mapping/ablation catheter. RESULTS:All seven patients had tachycardia foci originating from the superior region of the MA in close proximity to the left fibrous trigone and mitral-aortic continuity. These foci demonstrated a characteristic P-wave morphology and endocardial activation pattern. The P-wave morphology in the precordial leads typically showed a biphasic pattern, with an inverted component followed by an upright component. The P-wave was consistently of low amplitude in the limb leads. Earliest endocardial activity occurred at the His bundle region in all seven patients. In general, CS activation was proximal to distal, and mid-CT activation was earlier than high or low CT. Ablation was successful at the superior aspect of the MA in all patients. CONCLUSIONS:The MA is an unusual but important site of origin for focal atrial tachycardia, with a propensity to be localized to the superior aspect. It can be suspected as a potential anatomic site of tachycardia origin from analysis of P-wave morphology and the atrial endocardial activation sequence map. Using mapping targeted to anatomic structures achieved a high success rate for ablation.
Keywords: Heart Conduction System; Mitral Valve; Humans; Tachycardia, Ectopic Atrial; Echocardiography; Catheter Ablation; Severity of Illness Index; Follow-Up Studies; Electrophysiology; Time Factors; Adult; Aged; Middle Aged; Outcome Assessment (Health Care); Female; Male
Description: © 2003 by the American College of Cardiology Foundation. Published by Elsevier Inc.
RMID: 0020071949
DOI: 10.1016/S0735-1097(03)00484-4
Appears in Collections:Medicine publications

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