Characteristics and Catheter Ablation of Focal Atrial Tachycardia Originating From the Interatrial Septum

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• 作者：Yoshiaki Kaneko ; MD^a ; ^{kanekoy@gunma-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; ^&lsquo ; Ritsushi Kato ; MD^b ; Shiro Nakahara ; MD^c ; Takeshi Tobiume ; MD^d ; Itsuro Morishima ; MD^e ; Kazuhiko Tanaka ; MD^f ; Tadashi Nakajima ; MD^a ; Tadanobu Irie ; MD^a ; Kengo Fukushima Kusano ; MD^g ; Shiro Kamakura ; MD^g ; Takahiko Nagase ; MD^b ; Kan Takayanagi ; MD^c ; Kazuo Matsumoto ; MD^b ; Masahiko Kurabayashi ; MD^a
• 关键词：Ectopic atrial tachycardia ; Electrical catheter ablation ; Cardiac electrophysiology ; Atrial septum ; Electrocardiogram
• 刊名：Heart, Lung and Circulation
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：24
• 期：10
• 页码：988-995
• 全文大小：1298 K

文摘

Ablation of focal atrial tachycardia (AT) originating from the interatrial septum (IAS) is challenging because of its complex anatomy.

Methods

We studied the electrocardiographic and electrophysiologic characteristics of focal, septal AT in seven patients who underwent successful ablation.

Results

The site of successful ablation was at the site of earliest activation on the right side of the IAS in three patients and on the left side in four patients, >1 cm away from the centre of the fossa ovalis in the septum secundum. A negative or +/- versus a positive or -/+ P wave in lead V₁ during AT accurately predicted a right- versus left-sided origin of the AT, respectively. In the four left septal AT cases, right atrial activation mapping opposite the site of successful ablation revealed the presence of a small, low-frequency potential followed by a larger, high-frequency potential. In contrast, a high-frequency potential was not preceded by a low-frequency potential in the three right septal AT cases.

Conclusions

Septal AT may originate from either side of the septum secundum. The P wave polarity in lead V₁ accurately predicted the side of the IAS that the AT originated from. Left septal AT is characterised by the recording of double potentials reflecting far-field activation of the left-sided IAS, followed by near-field activation of the right-sided IAS, when recording from its right side, opposite the AT origin. These observations are particularly relevant when mapping an apparent right septal AT.