"Cristal tachycardias": origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography
JM Kalman,
JE Olgin,
MR Karch,
M Hamdan,
RJ Lee,
and
MD Lesh
Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, USA.
OBJECTIVES: We sought to use intracardiac echocardiography (ICE) to identify the anatomic origin of focal right atrial tachycardias and to define their relation with the crista terminalis (CT). BACKGROUND: Previous studies using ICE during mapping of atrial flutter and inappropriate sinus tachycardia have demonstrated an important relation between endocardial anatomy and electrophysiologic events. Recent studies have suggested that right atrial tachycardias may also have a characteristic anatomic distribution. METHODS: Twenty-three consecutive patients with 27 right atrial tachycardias were included in the study. ICE was used to facilitate activation mapping in relation to endocardial structures. A 20-pole catheter was positioned along the CT under ICE guidance. ICE was also used to assist in guiding detailed mapping with the ablation catheter in the right atrium. RESULTS: Of 27 focal right atrial tachycardias, 18 (67%, 95% confidence interval [CI] 46% to 83%) were on the CT (2 high medial, 8 high lateral, 6 mid and 2 low). ICE identified the location of the tip of the ablation catheter in immediate relation to the CT in all 18 cases. The 20-pole mapping catheter together with echocardiographic visualization of the CT provided a guide to the site of tachycardia origin along this structure. Radiofrequency ablation was successful in 26 (96%) of 27 (95% CI 81% to 100%) right atrial tachycardias. CONCLUSIONS: This study demonstrates that approximately two thirds of focal right atrial tachycardias occurring in the absence of structural heart disease will arise along the CT. Recognition of this common distribution may potentially facilitate mapping and ablation of these tachycardias.
This article has been cited by other articles:

|
 |

|
 |
 
M. R. Boyett
\#8216;And the beat goes on' The cardiac conduction system: the wiring system of the heart
Exp Physiol,
October 1, 2009;
94(10):
1035 - 1049.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Rillig, U. Meyerfeldt, R. Birkemeyer, and W. Jung
Ablation within the sinus of Valsalva for treatment of supraventricular and ventricular tachycardias: what is known so far?
Europace,
September 1, 2009;
11(9):
1142 - 1150.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. S. Kim, Z. M. Hijazi, R. M. Lang, and B. P. Knight
The use of intracardiac echocardiography and other intracardiac imaging tools to guide noncoronary cardiac interventions.
J. Am. Coll. Cardiol.,
June 9, 2009;
53(23):
2117 - 2128.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Medi, J. M. Kalman, H. Haqqani, J. K. Vohra, J. B. Morton, P. B. Sparks, and P. M. Kistler
Tachycardia-mediated cardiomyopathy secondary to focal atrial tachycardia: long-term outcome after catheter ablation.
J. Am. Coll. Cardiol.,
May 12, 2009;
53(19):
1791 - 1797.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. D'Amato, O. Pierfelice, and C. D'Agostino
Crista terminalis bridge: a rare variant mimicking right atrial mass
Eur J Echocardiogr,
May 1, 2009;
10(3):
444 - 445.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. Dobrev
Ion Channel Portrait of the Human Sinus Node: Useful for a Better Understanding of Sinus Node Function and Dysfunction in Humans?
Circulation,
March 31, 2009;
119(12):
1556 - 1558.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. J. Chandler, I. D. Greener, J. O. Tellez, S. Inada, H. Musa, P. Molenaar, D. DiFrancesco, M. Baruscotti, R. Longhi, R. H. Anderson, et al.
Molecular Architecture of the Human Sinus Node: Insights Into the Function of the Cardiac Pacemaker
Circulation,
March 31, 2009;
119(12):
1562 - 1575.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J.#x.;n. Farré, H. J.J. Wellens, J.#x. M. Rubio, and J. Benezet
CHAPTER 28 Supraventricular Tachycardias
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Kriatselis, M. Roser, T. Min, G. Evangelidis, M. Hoher, E. Fleck, and H. Gerds-Li
Ectopic atrial tachycardias with early activation at His site: radiofrequency ablation through a retrograde approach
Europace,
June 1, 2008;
10(6):
698 - 704.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
X. Freixa, A. Berruezo, L. Mont, S. Magnani, B. Benito, J. M. Tolosana, P. Perafan, D. Tamborero, and J. Brugada
Characterization of focal right atrial appendage tachycardia
Europace,
January 1, 2008;
10(1):
105 - 109.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
F. Saremi and S. Krishnan
Cardiac Conduction System: Anatomic Landmarks Relevant to Interventional Electrophysiologic Techniques Demonstrated with 64-Detector CT
RadioGraphics,
November 1, 2007;
27(6):
1539 - 1565.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. McKay and L. Thomas
Prominent crista terminalis and Eustachian ridge in the right atrium: Two dimensional (2D) and three dimensional (3D) imaging
Eur J Echocardiogr,
August 1, 2007;
8(4):
288 - 291.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. M. Markowitz, D. Nemirovksy, K. M. Stein, S. Mittal, S. Iwai, B. K. Shah, D. P. Dobesh, and B. B. Lerman
Adenosine-Insensitive Focal Atrial Tachycardia: Evidence for De Novo Micro-Re-Entry in the Human Atrium
J. Am. Coll. Cardiol.,
March 27, 2007;
49(12):
1324 - 1333.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. M. Kistler, K. C. Roberts-Thomson, H. M. Haqqani, S. P. Fynn, S. Singarayar, J. K. Vohra, J. B. Morton, P. B. Sparks, and J. M. Kalman
P-Wave Morphology in Focal Atrial Tachycardia: Development of an Algorithm to Predict the Anatomic Site of Origin
J. Am. Coll. Cardiol.,
September 5, 2006;
48(5):
1010 - 1017.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
F. Ouyang, J. Ma, S. Y. Ho, D. Bansch, B. Schmidt, S. Ernst, K.-H. Kuck, S. Liu, H. Huang, M. Chen, et al.
Focal Atrial Tachycardia Originating From the Non-Coronary Aortic Sinus: Electrophysiological Characteristics and Catheter Ablation
J. Am. Coll. Cardiol.,
July 4, 2006;
48(1):
122 - 131.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. R Kuo and N. A Trayanova
Action potential morphology heterogeneity in the atrium and its effect on atrial reentry: a two-dimensional and quasi-three-dimensional study
Phil Trans R Soc A,
June 15, 2006;
364(1843):
1349 - 1366.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Sanders, M. Hocini, P. Jais, L.-F. Hsu, Y. Takahashi, M. Rotter, C. Scavee, J.-L. Pasquie, F. Sacher, T. Rostock, et al.
Characterization of Focal Atrial Tachycardia Using High-Density Mapping
J. Am. Coll. Cardiol.,
December 6, 2005;
46(11):
2088 - 2099.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Bagwe, O. Berenfeld, D. Vaidya, G. E. Morley, and J. Jalife
Altered Right Atrial Excitation and Propagation in Connexin40 Knockout Mice
Circulation,
October 11, 2005;
112(15):
2245 - 2253.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. M. Kistler, S. P. Fynn, H. Haqqani, I. H. Stevenson, J. K. Vohra, J. B. Morton, P. B. Sparks, and J. M. Kalman
Focal Atrial Tachycardia From the Ostium of the Coronary Sinus: Electrocardiographic and Electrophysiological Characterization and Radiofrequency Ablation
J. Am. Coll. Cardiol.,
May 3, 2005;
45(9):
1488 - 1493.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Higa, C.-T. Tai, Y.-J. Lin, T.-Y. Liu, P.-C. Lee, J.-L. Huang, M.-H. Hsieh, Y. Yuniadi, B.-H. Huang, S.-H. Lee, et al.
Focal Atrial Tachycardia: New Insight From Noncontact Mapping and Catheter Ablation
Circulation,
January 6, 2004;
109(1):
84 - 91.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T.-a. Matsuyama, S. Inoue, Y. Kobayashi, T. Sakai, T. Saito, T. Katagiri, and H. Ota
Anatomical diversity and age-related histological changes in the human right atrial posterolateral wall
Europace,
January 1, 2004;
6(4):
307 - 315.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. M. Kistler, P. Sanders, S. P. Fynn, I. H. Stevenson, A. Hussin, J. K. Vohra, P. B. Sparks, and J. M. Kalman
Electrophysiological and Electrocardiographic Characteristics of Focal Atrial Tachycardia Originating From the Pulmonary Veins: Acute and Long-Term Outcomes of Radiofrequency Ablation
Circulation,
October 21, 2003;
108(16):
1968 - 1975.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Committee Members, C. Blomstrom-Lundqvist, M. M. Scheinman, E. M. Aliot, J. S. Alpert, H. Calkins, A. J. Camm, W. B. Campbell, D. E. Haines, K. H. Kuck, et al.
ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias --executive summary: a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) Developed in Collaboration with NASPE-Heart Rhythm Society
J. Am. Coll. Cardiol.,
October 15, 2003;
42(8):
1493 - 1531.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Blomstrom-Lundqvist, M. M. Scheinman, E. M. Aliot, J. S. Alpert, H. Calkins, A. J. Camm, W. B. Campbell, D. E. Haines, K. H. Kuck, B. B. Lerman, et al.
ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias*--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias)
Circulation,
October 14, 2003;
108(15):
1871 - 1909.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Committee Members, C. Blomstrom-Lundqvist, M. M Scheinman, E. M Aliot, J. S Alpert, H. Calkins, A.J. Camm, W.B. Campbell, D. E Haines, K. H Kuck, et al.
ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: A Report of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines(Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias)Developed in collaboration with NASPE-Heart Rhythm Society
Eur. Heart J.,
October 2, 2003;
24(20):
1857 - 1897.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. M. Kistler, P. Sanders, A. Hussin, J. B. Morton, J. K. Vohra, P. B. Sparks, and J. M. Kalman
Focal atrial tachycardia arising from the mitral annulus: Electrocardiographic and electrophysiologic characterization
J. Am. Coll. Cardiol.,
June 18, 2003;
41(12):
2212 - 2219.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Iwai, S. M. Markowitz, K. M. Stein, S. Mittal, D. J. Slotwiner, M. K. Das, J. D. Cohen, S. C. Hao, and B. B. Lerman
Response to Adenosine Differentiates Focal From Macroreentrant Atrial Tachycardia: Validation Using Three-Dimensional Electroanatomic Mapping
Circulation,
November 26, 2002;
106(22):
2793 - 2799.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D Sanchez-Quintana, R H Anderson, J A Cabrera, V Climent, R Martin, J Farre, and S Y Ho
The terminal crest: morphological features relevant to electrophysiology
Heart,
October 1, 2002;
88(4):
406 - 411.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. F. Marrouche, A. SippensGroenewegen, Y. Yang, S. Dibs, and M. M. Scheinman
Clinical and electrophysiologic characteristics of left septal atrial tachycardia
J. Am. Coll. Cardiol.,
September 18, 2002;
40(6):
1133 - 1139.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
U. Wetzel, G. Hindricks, P. Schirdewahn, A. Dorszewski, A. Fleck, F. Heinke, and H. Kottkamp
A stepwise mapping approach for localization and ablation of ectopic right, left, and septal atrial foci using electroanatomic mapping
Eur. Heart J.,
September 1, 2002;
23(17):
1387 - 1393.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. L. Packer, C. L. Stevens, M. G. Curley, C. J. Bruce, F. A. Miller, B. K. Khandheria, J. K. Oh, L. J. Sinak, and J. B. Seward
Intracardiac phased-array imaging: methods and initial clinical experience with high resolution, under blood visualization: Initial experience with intracardiac phased-array ultrasound
J. Am. Coll. Cardiol.,
February 6, 2002;
39(3):
509 - 516.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N Saoudi, F Cosio, A Waldo, S.A Chen, Y Iesaka, M Lesh, S Saksena, J Salerno, and W Schoels
A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases. A Statement from a Joint Expert Group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology
Eur. Heart J.,
July 2, 2001;
22(14):
1162 - 1182.
[PDF]
|
 |
|

|
 |

|
 |
 
B. Zrenner, G. Ndrepepa, M. Schneider, M. Karch, F. Hofmann, A. Schomig, and C. Schmitt
Computer-assisted animation of atrial tachyarrhythmias recorded with a 64-electrode basket catheter
J. Am. Coll. Cardiol.,
December 1, 1999;
34(7):
2051 - 2060.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. N. Doshi, T.-J. Wu, M. Yashima, Y.-H. Kim, J. J. C. Ong, J.-M. Cao, C. Hwang, P. Yashar, M. C. Fishbein, H. S. Karagueuzian, et al.
Relation Between Ligament of Marshall and Adrenergic Atrial Tachyarrhythmia
Circulation,
August 24, 1999;
100(8):
876 - 883.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Schmitt, B. Zrenner, M. Schneider, M. Karch, G. Ndrepepa, I. Deisenhofer, S. Weyerbrock, J. Schreieck, and A. Schomig
Clinical Experience With a Novel Multielectrode Basket Catheter in Right Atrial Tachycardias
Circulation,
May 11, 1999;
99(18):
2414 - 2422.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. J. Callans, J.-F. Ren, D. Schwartzman, C. D. Gottlieb, F. A. Chaudhry, and F. E. Marchlinski
Narrowing of the superior vena cava-right atrium junction during radiofrequency catheter ablation for inappropriate sinus tachycardia: analysis with intracardiac echocardiography
J. Am. Coll. Cardiol.,
May 1, 1999;
33(6):
1667 - 1670.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. A. Blom, A. C. Gittenberger-de Groot, M. C. DeRuiter, R. E. Poelmann, M. M. T. Mentink, and J. Ottenkamp
Development of the Cardiac Conduction Tissue in Human Embryos Using HNK-1 Antigen Expression : Possible Relevance for Understanding of Abnormal Atrial Automaticity
Circulation,
February 16, 1999;
99(6):
800 - 806.
[Abstract]
[Full Text]
[PDF]
|
 |
|
|