Atrial Tachycardia Arising From the Crista Terminalis, Detailed Electrophysiological Features and Long-Term Ablation Outcomes.

Authors:
Gwilym M Morris
Gwilym M Morris
University of Manchester
United Kingdom
Louise Segan
Louise Segan
Monash University
Gareth Wynn
Gareth Wynn
Institute of Cardiovascular Medicine and Science
United Kingdom
Troy Watts
Troy Watts
St Bartholomew's Hospital
Patrick Heck
Patrick Heck
Papworth Hospital NHS Foundation Trust
Tomos E Walters
Tomos E Walters
Royal Melbourne Hospital
Australia
Dr Ashley Nisbet, BSc (Hons) MBChB MRCP (UK) PhD
Dr Ashley Nisbet, BSc (Hons) MBChB MRCP (UK) PhD
Royal Melbourne Hospital
Cardiology; Cardiac electrophysiology
Melbourne, Victoria | Australia

JACC Clin Electrophysiol 2019 Apr 27;5(4):448-458. Epub 2019 Mar 27.

Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia. Electronic address:

Objectives: The goal of this study was to characterize, in detail, focal atrial tachycardia (AT) arising from the crista terminalis to investigate associations with other atrial arrhythmia and to define long-term ablation outcomes.

Background: The crista terminalis is known to be the most common site of origin for focal AT, but it is not well characterized.

Methods: This study retrospectively identified a total of 548 ablation procedures for AT performed at a single center over a 16-year period, of which 171 were arising from the crista terminalis.

Results: Compared with patients with other AT sites of origin, crista terminalis AT patients were older (57.3 vs. 47.3 years), more commonly female (72.9% vs. 59.1%), were more commonly associated with coexistent atrioventricular nodal re-entry tachycardia (17.1% vs. 9.7%), and were more likely to be inducible with programmed stimulation (81.5% vs. 58.9%). There was preferential conduction in the superior-inferior axis along the crista terminalis. Acute ablation success rate was high (92.2%) and improved significantly when three-dimensional mapping was used (98.5%). Recurrence in the first 12 months after a successful ablation was 9.7%. Only 2 patients developed atrial fibrillation over the long-term follow-up of >7 years.

Conclusions: This large series characterized the clinical and electrophysiological features and immediate and long-term ablation outcomes for AT originating from the crista terminalis. Features of the tachycardia suggest that age-related localized remodeling of the crista terminalis causes a superficial endocardial zone of conduction slowing leading to re-entry. Ablation outcomes were good, with long-term freedom from atrial arrhythmia.

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Source
http://dx.doi.org/10.1016/j.jacep.2019.01.014DOI Listing
April 2019
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