Korean Circ J.  2010 May;40(5):235-238. 10.4070/kcj.2010.40.5.235.

Coexisting Sustained Tachyarrthymia in Patients With Atrial Fibrillation Undergoing Catheter Ablation

• Jang JK
• Park JS
• Kim YH
• Choi JI
• Lim HE
• Pak HN
• Kim YH

• KMID: 1456368
• DOI: http://doi.org/10.4070/kcj.2010.40.5.235

Abstract

BACKGROUND AND OBJECTIVES
During the index procedure of catheter ablation (CA) for atrial fibrillation (AF), it is important to assess whether other atrial or ventricular tachyarrhythmia coexist. Their symptoms are often attributed to residual tachycardia after successful elimination of AF by CA. This tachycardia could also be non-pulmonary vein (PV) foci initiated AF. This study examined the coexistence of other sustained tachyarrhythmia of patients who underwent radiofrequency CA (RFCA) for AF.
SUBJECTS AND METHODS
Four hundred fifty-nine consecutive patients (375 males, aged 53.4+/-11.4 years) who underwent RFCA for AF were investigated. Atrial and ventricular programmed stimulation (PS) with or without isoproterenol infusion were performed, and spontaneously developed tachycardias were analyzed.
RESULTS
Fifteen patients (3.3% of total) were diagnosed to have other sustained arrhythmias that included slow-fast type atrioventricular nodal reentrant tachycardia (AVNRT, n=6), atrioventricular reentrant tachycardia (AVRT, n=5) that utilized left posteroseptal (n=4) and parahisian bypass tract (n=1), atrial tachycardia (AT, n=2) originating from the foramen ovale (n=1) and the ostium of coronary sinus (n=1), sustained ventricular tachycardia (VT, n=2) involving one from the apical posterolateral wall of left ventricule in a normal heart and one from an anterolateral wall in an underlying myocardial infarction (MI). These sustained tachycardias were neither clinically documented nor had structural heart diseases, with the exception of one patient with MI associated VT. Two patients had the triple tachycardia; one involved AVNRT, AVRT, and AF, and the other involved VT, AT, and AF. All associated tachycardias were successfully eliminated by RFCA.
CONCLUSION
Fifteen (3.3%) patients with AF had coexisting sustained tachycardia. RFCA was successful in these patients. Identification of tachycardia by PS before RFCA for AF should be done to maximize the efficacy of the first ablation session.

Keyword

Atrial fibrillation; Tachycardia supraventricular; Catheter ablation

MeSH Terms

Aged
Arrhythmias, Cardiac
Atrial Fibrillation
Catheter Ablation
Catheters
Coronary Sinus
Foramen Ovale
Heart
Heart Diseases
Humans
Isoproterenol
Male
Myocardial Infarction
Tachycardia
Tachycardia, Atrioventricular Nodal Reentry
Tachycardia, Ventricular
Veins
Isoproterenol

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