This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kistler, P. M. Articles by Kalman, J. M. Search for Related Content PubMed PubMed Citation Articles by Kistler, P. M. Articles by Kalman, J. M.

CLINICAL RESEARCH: ATRIAL FIBRILLATION/FLUTTER, TACHYCARDIA

Focal atrial tachycardia arising from the mitral annulus

Electrocardiographic and electrophysiologic characterization

^* Department of Cardiology, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne, Melbourne, Australia

Manuscript received October 28, 2002; revised manuscript received March 2, 2003, accepted March 20, 2003.

^* Reprint requests and correspondence: Dr. Jonathan M. Kalman, Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia 3050.
jon.kalman{at}mh.org.au

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.

Abbreviations and Acronyms   AT   atrial tachycardia   CS   coronary sinus   CT   crista terminalis   LA   left atrium   MA   mitral annulus   PV   pulmonary vein   RA   right atrium   RFA   radiofrequency ablation

This article has been cited by other articles:

				N W F Linton and S W Dubrey Narrow complex (supraventricular) tachycardias Postgrad. Med. J., October 1, 2009; 85(1008): 546 - 551. [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]

				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]

				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]

				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]

				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]

				M.R.M. Jongbloed, M.C.E.F. Wijffels, M.J. Schalij, N.A. Blom, R.E. Poelmann, A. van der Laarse, M.M.T. Mentink, Z. Wang, G.I. Fishman, and A.C. Gittenberger-de Groot Development of the Right Ventricular Inflow Tract and Moderator Band: A Possible Morphological and Functional Explanation for Mahaim Tachycardia Circ. Res., April 15, 2005; 96(7): 776 - 783. [Abstract] [Full Text] [PDF]

				H. Tada, S. Ito, S. Naito, K. Kurosaki, S. Kubota, A. Sugiyasu, T. Tsuchiya, K. Miyaji, M. Yamada, Y. Kutsumi, et al. Idiopathic ventricular arrhythmia arising from the mitral annulus: A distinct subgroup of idiopathic ventricular arrhythmias J. Am. Coll. Cardiol., March 15, 2005; 45(6): 877 - 886. [Abstract] [Full Text] [PDF]

				A. T. Soufan, M. J.B. van den Hoff, J. M. Ruijter, P. A.J. de Boer, J. Hagoort, S. Webb, R. H. Anderson, and A. F.M. Moorman Reconstruction of the Patterns of Gene Expression in the Developing Mouse Heart Reveals an Architectural Arrangement That Facilitates the Understanding of Atrial Malformations and Arrhythmias Circ. Res., December 10, 2004; 95(12): 1207 - 1215. [Abstract] [Full Text] [PDF]

				M. D. Gonzalez, L. J. Contreras, M. R.M. Jongbloed, J. Rivera, T. P. Donahue, A. B. Curtis, M. S. Bailey, J. B. Conti, G. I. Fishman, M. J. Schalij, et al. Left Atrial Tachycardia Originating From the Mitral Annulus-Aorta Junction Circulation, November 16, 2004; 110(20): 3187 - 3192. [Abstract] [Full Text] [PDF]

				C.e. E. Mesas, C. Pappone, C. C.E. Lang, F. Gugliotta, T. Tomita, G. Vicedomini, S. Sala, G. Paglino, S. Gulletta, A. Ferro, et al. Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: Electroanatomic characterization and treatment J. Am. Coll. Cardiol., September 1, 2004; 44(5): 1071 - 1079. [Abstract] [Full Text] [PDF]

				D. B Hoover, C. E Ganote, S. M Ferguson, R. D Blakely, and R. L Parsons Localization of cholinergic innervation in guinea pig heart by immunohistochemistry for high-affinity choline transporters Cardiovasc Res, April 1, 2004; 62(1): 112 - 121. [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]