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CLINICAL STUDY: ELECTROPHYSIOLOGY

Clinical and electrophysiologic characteristics of left septal atrial tachycardia

^* Section of Cardiac Electrophysiology, Department of Cardiology, University of California, San Francisco, California, USA

Manuscript received September 18, 2001; revised manuscript received June 5, 2002, accepted June 12, 2002.

^* Reprint requests and correspondence: Dr. Melvin M. Scheinman, Section of Cardiac Electrophysiology, Department of Cardiology, University of California, San Francisco, 500 Parnassus Avenue/MU 434, San Francisco, California 94143, USA
Scheinman{at}medicine.ucsf.edu

OBJECTIVES: It was the purpose of this study to define the electrophysiologic (EP) identity of left septal atrial tachycardia (AT).

BACKGROUND: The clinical and EP characteristics of this particular type of arrhythmia have not been fully described.

METHODS: A total of 120 patients with AT underwent invasive EP evaluation. Five patients (two men and three women; mean age 49 ± 15 years) with left septal AT were identified. Mapping of the right and left atrium was performed using conventional electrode catheters (five patients) and a three-dimensional electroanatomic mapping system (three patients) followed by radiofrequency (RF) ablation at the earliest site of local endocardial activation.

RESULTS: Five tachycardias with a mean cycle length of 320 ± 94 ms were mapped, and the earliest endocardial electrogram occurred 22 ± 10 ms before the onset of the surface P-wave. Three left septal ATs were found to be originating from the left inferoposterior atrial septum and two from the left midseptum. During tachycardia, positive (three patients), biphasic negative-positive deflection (one patient), or isoelectric (one patient) P waves were recorded in lead V₁. The inferior leads demonstrated a positive or biphasic P-wave morphology in four of five patients (80%). Four patients were given both adenosine and verapamil during AT. In three of four patients, verapamil successfully terminated AT after adenosine had failed. Adenosine successfully terminated AT in one of four patients. Successful RF ablation was performed in all patients (mean 2.2 ± 1.7 RF applications) without affecting atrioventricular conduction properties. No recurrence of AT was observed after a mean follow-up of 14 ± 8 months.

CONCLUSIONS: Left septal AT ablation is safe and effective. There was no consistent P-wave morphology associated with this particular type of AT. This arrhythmia appears to be resistant to adenosine and moderately responsive to calcium antagonists.

Abbreviations and Acronyms   A-A-V   atrial-atrial-ventricular pattern   A-H   atrial-His interval   AT   atrial tachycardia   AV   atrioventricular   CS   coronary sinus   ECG   electrocardiogram/electrocardiographic   EP   electrophysiologic   RF   radiofrequency   SVT   supraventricular tachycardia   VA   ventriculoatrial

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