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Clinical Features and Ablation of Four Cases of Focal Atrial Tachycardia Arising from the Left Atrial Roof
Abstracts
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the therapeutic option of anti-tachycardia pacing for painless ventricular tachycardia termination. Conclusion: Our case demonstrates that subcutaneous ICD insertion for secondary prevention of arrhythmia is a suitable alternative for patients with complicated venous anatomy. http://dx.doi.org/10.1016/j.hlc.2017.06.307 307 Characteristics and Long-Term Outcomes of Patients with Left Ventricular Papillary Muscle Arrhythmias R. Pathak ∗ , A. Kochar, J. Gordon, F. Marchlinski, S. Dixit University of Pennsylvania Health System, Philadelphia, USA Background: Ventricular arrhythmias (VAs) can originate from the left ventricular (LV) papillary muscles (PMs). In addition to causing potentially debilitating symptoms, VAs can cause significant left ventricular (LV) dysfunction. Methods: 185 patients had PVCs activation and pace mapped to the LV PMs. The clinical characteristics, aetiology and outcomes of patients were investigated. Results: At baseline, 76 (41%) had normal LVEF and 109 (59%) low LVEF (mean LVEF 30.5 ± 10.5%). PM VAs were PVCs in 123 (67%) and non-sustained VT in 61 pts (33%). Site of origin was the LV postero-medial PM in 106 (57%) and LV antero-lateral PM in 69 (37%) and both PMs in 10 pts (6%). 140 pts (76%) had idiopathic VAs and in 45 pts (24%) the site of origin of VA was confined to endocardial scar tissue. Acute success was achieved in 91% of patients. During the 65 ± 37 months of follow-up, VA free survival was 85% after a single procedure and 93% after repeat procedure. On multivariate analysis, presence of structural heart disease (HR 2.16 CI: 1.4 to 3.9 p = 006) and number of distinct PVC morphology (HR 1.5 CI: CI: 1.2 to 1.9 p = 0.02) were independent predictors of VA recurrence. After successful ablation, in pts with idiopathic VA, the mean LV ejection fraction improved from 29.7 ± 12.5% to 53.1 ± 2.5% vs. 30.5 ± 11.3% to 45.1 ± 6.5% in scar related VAs (p = 0.02). Conclusion: Catheter ablation of frequent VAs is a low-risk and effective treatment strategy. http://dx.doi.org/10.1016/j.hlc.2017.06.308
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308 Clinical Features and Ablation of Four Cases of Focal Atrial Tachycardia Arising from the Left Atrial Roof A. Lee 1,2,∗ , M. Kumar 3 , L. Skirrow 4 , J. Betts 1 , O. Davison 1 , H. Haqqani 1,2,4 1 The Prince Charles Hospital, Brisbane, Australia 2 The University of Queensland, Brisbane, Australia 3 Mackay Base Hospital, Mackay, Australia 4 Holy Spirit Northside Private Hospital, Brisbane, Australia
Introduction: Focal atrial tachycardia (FAT) arising from the left atrial (LA) roof is rare. We describe the clinical and electrophysiology features of this arrhythmia. Methods: Between 2011-2017, 4 cases of FAT arising from the LA roof underwent radiofrequency ablation (RFA) at our centre. Medical records were retrospectively reviewed. Results: All pts presented with incessant AT. All had palpitations, 2 suffered dypsnoea and dizziness. Two pts had structurally normal hearts, 1 pt had a tachycardio-myopathy (LVEF 25%) and 1 pt had underlying hypertrophic cardiomyopathy. Three pts had P-wave morphologies mimicking the left superior pulmonary vein (PV) with positive, bifid Pwaves in V1, inferior axis and P-waves of equal or greater width than in sinus rhythm (SR). The remaining pt had P-wave features of both right and left superior PV origin: positive and monophasic in V1, biphasic and inferiorly directed in II and narrower than that in SR. One pt had a 2nd focus consistent with a right atrial appendage origin. No pts had a history of AF. All pts underwent successful transseptal RFA after failing at least 1 anti-arrhythmic agent. PV sites were either late or on-time. The earliest sites (24-34 ms pre-P wave) were the posterior LA roof (2 pts), mid roof (1 pt) and anterior roof (1 pt). No recurrences have occurred at 8 months median follow-up. The pt with cardiomyopathy recovered (EF 54%). Conclusions: The LA roof is a rare FAT site of origin. Clinical presentation mimics incessant PV AT. Medical therapy is often ineffective; RFA is curative. http://dx.doi.org/10.1016/j.hlc.2017.06.309 309 Critical Interventions Resulting from a Universal Home Monitoring Service in Western Sydney D. Selvakumar ∗ , S. Brown, R. Denniss, P. Kovoor, S. Kumar, C. Chow, G. Sivagangabalan Westmead Hospital, Sydney, Australia Background: In the past decade clinical evidence has led to the introduction of reimbursement and guideline recommendations advocating the use of remote monitoring (RM) for cardiac implantable electronic devices (CIED). Aim: To describe CIED abnormalities identified by RM.
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the therapeutic option of anti-tachycardia pacing for painless ventricular tachycardia termination. Conclusion: Our case demonstrates that subcutaneous ICD insertion for secondary prevention of arrhythmia is a suitable alternative for patients with complicated venous anatomy. http://dx.doi.org/10.1016/j.hlc.2017.06.307 307 Characteristics and Long-Term Outcomes of Patients with Left Ventricular Papillary Muscle Arrhythmias R. Pathak ∗ , A. Kochar, J. Gordon, F. Marchlinski, S. Dixit University of Pennsylvania Health System, Philadelphia, USA Background: Ventricular arrhythmias (VAs) can originate from the left ventricular (LV) papillary muscles (PMs). In addition to causing potentially debilitating symptoms, VAs can cause significant left ventricular (LV) dysfunction. Methods: 185 patients had PVCs activation and pace mapped to the LV PMs. The clinical characteristics, aetiology and outcomes of patients were investigated. Results: At baseline, 76 (41%) had normal LVEF and 109 (59%) low LVEF (mean LVEF 30.5 ± 10.5%). PM VAs were PVCs in 123 (67%) and non-sustained VT in 61 pts (33%). Site of origin was the LV postero-medial PM in 106 (57%) and LV antero-lateral PM in 69 (37%) and both PMs in 10 pts (6%). 140 pts (76%) had idiopathic VAs and in 45 pts (24%) the site of origin of VA was confined to endocardial scar tissue. Acute success was achieved in 91% of patients. During the 65 ± 37 months of follow-up, VA free survival was 85% after a single procedure and 93% after repeat procedure. On multivariate analysis, presence of structural heart disease (HR 2.16 CI: 1.4 to 3.9 p = 006) and number of distinct PVC morphology (HR 1.5 CI: CI: 1.2 to 1.9 p = 0.02) were independent predictors of VA recurrence. After successful ablation, in pts with idiopathic VA, the mean LV ejection fraction improved from 29.7 ± 12.5% to 53.1 ± 2.5% vs. 30.5 ± 11.3% to 45.1 ± 6.5% in scar related VAs (p = 0.02). Conclusion: Catheter ablation of frequent VAs is a low-risk and effective treatment strategy. http://dx.doi.org/10.1016/j.hlc.2017.06.308
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308 Clinical Features and Ablation of Four Cases of Focal Atrial Tachycardia Arising from the Left Atrial Roof A. Lee 1,2,∗ , M. Kumar 3 , L. Skirrow 4 , J. Betts 1 , O. Davison 1 , H. Haqqani 1,2,4 1 The Prince Charles Hospital, Brisbane, Australia 2 The University of Queensland, Brisbane, Australia 3 Mackay Base Hospital, Mackay, Australia 4 Holy Spirit Northside Private Hospital, Brisbane, Australia
Introduction: Focal atrial tachycardia (FAT) arising from the left atrial (LA) roof is rare. We describe the clinical and electrophysiology features of this arrhythmia. Methods: Between 2011-2017, 4 cases of FAT arising from the LA roof underwent radiofrequency ablation (RFA) at our centre. Medical records were retrospectively reviewed. Results: All pts presented with incessant AT. All had palpitations, 2 suffered dypsnoea and dizziness. Two pts had structurally normal hearts, 1 pt had a tachycardio-myopathy (LVEF 25%) and 1 pt had underlying hypertrophic cardiomyopathy. Three pts had P-wave morphologies mimicking the left superior pulmonary vein (PV) with positive, bifid Pwaves in V1, inferior axis and P-waves of equal or greater width than in sinus rhythm (SR). The remaining pt had P-wave features of both right and left superior PV origin: positive and monophasic in V1, biphasic and inferiorly directed in II and narrower than that in SR. One pt had a 2nd focus consistent with a right atrial appendage origin. No pts had a history of AF. All pts underwent successful transseptal RFA after failing at least 1 anti-arrhythmic agent. PV sites were either late or on-time. The earliest sites (24-34 ms pre-P wave) were the posterior LA roof (2 pts), mid roof (1 pt) and anterior roof (1 pt). No recurrences have occurred at 8 months median follow-up. The pt with cardiomyopathy recovered (EF 54%). Conclusions: The LA roof is a rare FAT site of origin. Clinical presentation mimics incessant PV AT. Medical therapy is often ineffective; RFA is curative. http://dx.doi.org/10.1016/j.hlc.2017.06.309 309 Critical Interventions Resulting from a Universal Home Monitoring Service in Western Sydney D. Selvakumar ∗ , S. Brown, R. Denniss, P. Kovoor, S. Kumar, C. Chow, G. Sivagangabalan Westmead Hospital, Sydney, Australia Background: In the past decade clinical evidence has led to the introduction of reimbursement and guideline recommendations advocating the use of remote monitoring (RM) for cardiac implantable electronic devices (CIED). Aim: To describe CIED abnormalities identified by RM.