Electrophysiological characteristics of atrial tachycardia originating from the coronary sinus

Jie Wang, Zhihong Zhao, Xuebin Li, Jihong Guo

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DOI: 10.4236/ojim.2011.13012                

Abstract

A 22-year-old girl was admitted to our cardiology institute with Permanent tachycardia in last 6 years for diagnostic assessment and therapy. Doppler echocardiography show structural of heart is normal, ECG revealed a varied resting rate from 120 to 140 bpm, 1:1 AV ratio and long RP interval. P wave morphology was negative on leads I, II, III, aVF, and V4 to V6, positive on lead V1, and diphasic 1 /2 on lead aVL. Electrophysiology (EP) study was performed, Although the exactly mapping was performed in left inferior pulmonary vein and mitral annulus, however, no target point was found ahead of CS1-2, the tried discharge was invalid. The ablation catheter was entered the coronary sinus to guide electrical isolation, curing the tachycardia. The ECG returned to normal sinus rhythm. Through three years follow up, no AT recurrence.

Keywords

Coronary Sinus; Atrial Tachycardia; Catheter Ablation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Roberts-Thomson, K.C., Kistler, P.M. and Kalman, J.M. (2006) Focal atrial tachycardia I: Clinical features, diagnosis, mechanisms, and anatomic location. Pacing and Clinical Electrophysiology, 29, 643-652. doi:10.1111/j.1540-8159.2006.00413.x
[2]	Lesh, M.D., Kalman, J.M. and Olgin, J.E. (1996) New approaches to treatment of atrial flutter and tachycardia. Journal of Cardiovascular Electrophysiology, 7, 368-381. doi:10.1111/j.1540-8167.1996.tb00539.x
[3]	Chen, S.A., Tai, C.T., Chiang, C.E., Ding, Y.A. and Chang, M.S. (1998) Focal atrial tachycardia: Reanalysis of the clinical and electrophysiologic characteristics and prediction of successful radiofrequency ablation. Journal of Cardiovascular Electrophysiology, 9, 355-365. doi:10.1111/j.1540-8167.1998.tb00924.x
[4]	Kistler, P.M., Roberts-Thomson, K.C., Haqqani, H.M., Fynn, S.P., Singarayar, S., Vohra, J.K., Morton, J.B., Sparks, P.B. and Kalman, J.M. (2006) P-wave morphology in focal atrial tachycardia: Development of an algorithm to predict the anatomic site of origin. Journal of the American College of Cardiology, 48, 1010-1017. doi:10.1016/j.jacc.2006.03.058
[5]	Navarrete, A.J., Arora, R., Hubbard, J.E. and Miller, J.M. (2003) Magnetic electroanatomic mapping of an atrial tachycardia requiring ablation within the coronary sinus. Journal of Cardiovascular Electrophysiology, 14, 1361-1364. doi:10.1046/j.1540-8167.2003.03334.x
[6]	Kistler, P.M., Sanders, P., Fynn, S.P., Stevenson, I.H., Hussin, A., Vohra, J.K., Sparks, P.B. and Kalman, J.M. (2003) Electrophysiological and electrocardiographic characteristics of focal atrial tachycardia originating from the pulmonary veins: Acute and long-term outcomes of radiofrequency ablation. Circulation, 108, 1968-1975. doi:10.1161/01.CIR.0000095269.36984.75
[7]	Kistler, P.M., Sanders, P., Hussin, A., Morton, J.B., Vohra, J.K., Sparks, P.B. and Kalman, J.M. (2003) Focal atrial tachycardia arising from the mitral annulus: Electrocardiographic and electrophysiologic characterization. Journal of the American College of Cardiology, 41, 2212- 2219. doi:10.1016/S0735-1097(03)00484-4
[8]	Marrouche, N.F., SippensGroenewegen, A., Yang, Y., Dibs, S. and Scheinman, M.M. (2002) Clinical and electrophysiologic characteristics of left septal atrial tachycardia. Journal of the American College of Cardiology, 40, 1133-1139. doi:10.1016/S0735-1097(02)02071-5
[9]	Gonzalez, M.D., Contreras, L.J., Jongbloed, M.R., Rivera, J., Donahue, T.P., Curtis, A.B., Bailey, M.S., Conti, J.B., Fishman, G.I., Schalij, M.J. and Gittenberger-de-Groot, A.C. (2004) Left atrial tachycardia originating from the mitral annulus-aorta junction. Circulation, 110, 3187-3192. doi:10.1161/01.CIR.0000147613.45259.D1
[10]	Wang, Y.L., Li, X.B., Quan, X., Ma, J.X., Zhang, P., Xu, Y., Zhang, H.C. and Guo, J.H. (2007) Focal atrial tachycardia originating from the left atrial appendage: electrocardiographic and electrophysiologic characterization and long-term outcomes of radiofrequency ablation. Journal of Cardiovascular Electrophysiology, 18, 459- 464. doi:10.1111/j.1540-8167.2007.00808.x
[11]	Roberts-Thomson, K.C., Kistler, P.M., Haqqani, H.M., McGavigan, A.D., Hillock, R.J., Stevenson, I.H., Morton, J.B., Vohra, J.K., Sparks, P.B. and Kalman, J.M. (2007) Focal atrial tachycardias arising from the right atrial appendage: Electrocardiographic and electrophysiologic characteristics and radiofrequency ablation. Journal of Cardiovascular Electrophysiology, 18, 367-372. doi:10.1111/j.1540-8167.2006.00754.x
[12]	Kistler, P.M., Fynn, S.P., Haqqani, H., Stevenson, I.H., Vohra, J.K., Morton, J.B., Sparks, P.B. and Kalman, J.M. (2005) Focal atrial tachycardia from the ostium of the coronary sinus: Electrocardiographic and electrophysiological characterization and radiofrequency ablation. Journal of the American College of Cardiology, 45, 1488-1493. doi:10.1016/j.jacc.2005.01.042
[13]	Badhwar, N. Kalman, J.M., Sparks, P.B., Kistler, P.M., Attari, M., Berger, M., Lee, R.J., Sra, J. and Scheinman, M.M. (2005) Atrial tachycardia arising from the coronary sinus musculature: Electrophysiological characteristics and long-term outcomes of radiofrequency ablation. Journal of the American College of Cardiology, 46, 1921-1930. doi:10.1016/j.jacc.2005.07.042
[14]	Yamabe, H., Tanaka, Y., Okumura, K., Morikami, Y., Kimura, Y., Hokamura, Y. and Ogawa, H. (2005) Electrophysiologic characteristics of verapamil-sensitive atrial tachycardia originating from the atrioventricular annulus. American Journal of Cardiology, 95, 1425-1430. doi:10.1016/j.amjcard.2005.02.007
[15]	Yamada, T., Murakami, Y., Muto, M., Okada, T., Okamoto, M., Toyama, J., Yoshida, Y., Tsuboi, N., Ito, T., Kondo, T., Inden, Y., Hirai, M. and Murohara, T. (2004) Electrophysiologic characteristics of atrial tachycardia originating from the right pulmonary veins or posterior right atrium: double potentials obtained from the posterior wall of the right atrium can be useful to predict foci of atrial tachycardia in right pulmonary veins or posterior right atrium. Journal of Cardiovascular Electrophysiology, 15,
[16]	Frey, B., Kreiner, G., Gwechenberger, M. and Gossinger, H.D. (2001) Ablation of atrial tachycardia originating from the vicinity of the atrioventricular node: significance of mapping both sides of the interatrial septum. Journal of the American College of Cardiology, 38, 394-400. doi:10.1016/S0735-1097(01)01391-2
[17]	Zhao, Z., Li, X. and Guo, J. (2009) Electrophysiologic characteristics of atrial tachycardia originating from the superior vena cava. Journal of Interventional Cardiac Electrophysiology, 24, 89-94. doi:10.1007/s10840-008-9324-0
[18]	Mehta, A.V. and Ewing, L.L. (1993) Atrial tachycardia in infants and children: electrocardiographic classification and its significance. Pediatric Cardiology, 14, 199-203. doi:10.1007/BF00795370
[19]	Roberts-Thomson, K.C., Kistler, P.M. and Kalman, J.M. (2006) Focal atrial tachycardia I: Clinical features, diagnosis, mechanisms, and anatomic location. Pacing and Clinical Electrophysiology, 29, 643-652. doi:10.1111/j.1540-8159.2006.00413.x
[20]	Lesh, M.D., Kalman, J.M. and Olgin, J.E. (1996) New approaches to treatment of atrial flutter and tachycardia. Journal of Cardiovascular Electrophysiology, 7, 368-381. doi:10.1111/j.1540-8167.1996.tb00539.x
[21]	Chen, S.A., Tai, C.T., Chiang, C.E., Ding, Y.A. and Chang, M.S. (1998) Focal atrial tachycardia: Reanalysis of the clinical and electrophysiologic characteristics and prediction of successful radiofrequency ablation. Journal of Cardiovascular Electrophysiology, 9, 355-365. doi:10.1111/j.1540-8167.1998.tb00924.x
[22]	Kistler, P.M., Roberts-Thomson, K.C., Haqqani, H.M., Fynn, S.P., Singarayar, S., Vohra, J.K., Morton, J.B., Sparks, P.B. and Kalman, J.M. (2006) P-wave morphology in focal atrial tachycardia: Development of an algorithm to predict the anatomic site of origin. Journal of the American College of Cardiology, 48, 1010-1017. doi:10.1016/j.jacc.2006.03.058
[23]	Navarrete, A.J., Arora, R., Hubbard, J.E. and Miller, J.M. (2003) Magnetic electroanatomic mapping of an atrial tachycardia requiring ablation within the coronary sinus. Journal of Cardiovascular Electrophysiology, 14, 1361-1364. doi:10.1046/j.1540-8167.2003.03334.x
[24]	Kistler, P.M., Sanders, P., Fynn, S.P., Stevenson, I.H., Hussin, A., Vohra, J.K., Sparks, P.B. and Kalman, J.M. (2003) Electrophysiological and electrocardiographic characteristics of focal atrial tachycardia originating from the pulmonary veins: Acute and long-term outcomes of radiofrequency ablation. Circulation, 108, 1968-1975. doi:10.1161/01.CIR.0000095269.36984.75
[25]	Kistler, P.M., Sanders, P., Hussin, A., Morton, J.B., Vohra, J.K., Sparks, P.B. and Kalman, J.M. (2003) Focal atrial tachycardia arising from the mitral annulus: Electrocardiographic and electrophysiologic characterization. Journal of the American College of Cardiology, 41, 2212- 2219. doi:10.1016/S0735-1097(03)00484-4
[26]	Marrouche, N.F., SippensGroenewegen, A., Yang, Y., Dibs, S. and Scheinman, M.M. (2002) Clinical and electrophysiologic characteristics of left septal atrial tachycardia. Journal of the American College of Cardiology, 40, 1133-1139. doi:10.1016/S0735-1097(02)02071-5
[27]	Gonzalez, M.D., Contreras, L.J., Jongbloed, M.R., Rivera, J., Donahue, T.P., Curtis, A.B., Bailey, M.S., Conti, J.B., Fishman, G.I., Schalij, M.J. and Gittenberger-de-Groot, A.C. (2004) Left atrial tachycardia originating from the mitral annulus-aorta junction. Circulation, 110, 3187-3192. doi:10.1161/01.CIR.0000147613.45259.D1
[28]	Wang, Y.L., Li, X.B., Quan, X., Ma, J.X., Zhang, P., Xu, Y., Zhang, H.C. and Guo, J.H. (2007) Focal atrial tachycardia originating from the left atrial appendage: electrocardiographic and electrophysiologic characterization and long-term outcomes of radiofrequency ablation. Journal of Cardiovascular Electrophysiology, 18, 459- 464. doi:10.1111/j.1540-8167.2007.00808.x
[29]	Roberts-Thomson, K.C., Kistler, P.M., Haqqani, H.M., McGavigan, A.D., Hillock, R.J., Stevenson, I.H., Morton, J.B., Vohra, J.K., Sparks, P.B. and Kalman, J.M. (2007) Focal atrial tachycardias arising from the right atrial appendage: Electrocardiographic and electrophysiologic characteristics and radiofrequency ablation. Journal of Cardiovascular Electrophysiology, 18, 367-372. doi:10.1111/j.1540-8167.2006.00754.x
[30]	Kistler, P.M., Fynn, S.P., Haqqani, H., Stevenson, I.H., Vohra, J.K., Morton, J.B., Sparks, P.B. and Kalman, J.M. (2005) Focal atrial tachycardia from the ostium of the coronary sinus: Electrocardiographic and electrophysiological characterization and radiofrequency ablation. Journal of the American College of Cardiology, 45, 1488-1493. doi:10.1016/j.jacc.2005.01.042
[31]	Badhwar, N. Kalman, J.M., Sparks, P.B., Kistler, P.M., Attari, M., Berger, M., Lee, R.J., Sra, J. and Scheinman, M.M. (2005) Atrial tachycardia arising from the coronary sinus musculature: Electrophysiological characteristics and long-term outcomes of radiofrequency ablation. Journal of the American College of Cardiology, 46, 1921-1930. doi:10.1016/j.jacc.2005.07.042
[32]	Yamabe, H., Tanaka, Y., Okumura, K., Morikami, Y., Kimura, Y., Hokamura, Y. and Ogawa, H. (2005) Electrophysiologic characteristics of verapamil-sensitive atrial tachycardia originating from the atrioventricular annulus. American Journal of Cardiology, 95, 1425-1430. doi:10.1016/j.amjcard.2005.02.007
[33]	Yamada, T., Murakami, Y., Muto, M., Okada, T., Okamoto, M., Toyama, J., Yoshida, Y., Tsuboi, N., Ito, T., Kondo, T., Inden, Y., Hirai, M. and Murohara, T. (2004) Electrophysiologic characteristics of atrial tachycardia originating from the right pulmonary veins or posterior right atrium: double potentials obtained from the posterior wall of the right atrium can be useful to predict foci of atrial tachycardia in right pulmonary veins or posterior right atrium. Journal of Cardiovascular Electrophysiology, 15,
[34]	Frey, B., Kreiner, G., Gwechenberger, M. and Gossinger, H.D. (2001) Ablation of atrial tachycardia originating from the vicinity of the atrioventricular node: significance of mapping both sides of the interatrial septum. Journal of the American College of Cardiology, 38, 394-400. doi:10.1016/S0735-1097(01)01391-2
[35]	Zhao, Z., Li, X. and Guo, J. (2009) Electrophysiologic characteristics of atrial tachycardia originating from the superior vena cava. Journal of Interventional Cardiac Electrophysiology, 24, 89-94. doi:10.1007/s10840-008-9324-0
[36]	Mehta, A.V. and Ewing, L.L. (1993) Atrial tachycardia in infants and children: electrocardiographic classification and its significance. Pediatric Cardiology, 14, 199-203. doi:10.1007/BF00795370