Mapping and Ablation of Paraseptal Focal Atrial Tachycardias.

IF 7.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-08-02 DOI:10.1016/j.jacep.2025.06.022

Ivaylo R Tonchev, Arie L Schwartz, Ashley M Nisbet, David Chieng, Troy M Watts, Paul Sparks, Joseph B Morton, Geoffrey Lee, Peter M Kistler, Jonathan M Kalman

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引用次数: 0

Abstract

Background: Focal atrial tachycardia (AT) may arise from a range of closely related anatomical sites in the paraseptal region.

Objectives: This study sought to define the anatomical distribution and examine the electrocardiographic and electrophysiological features of paraseptal focal AT, suggest a mapping approach, and report ablation outcomes.

Methods: This retrospective single-center study defined paraseptal ATs as originating from the following anatomical sites: right perinodal region, septal tricuspid annulus, right septum, coronary sinus (CS) ostium, left septum, septal mitral annulus, aorto-mitral continuity, and non-coronary cusp (NCC) adjacent. Early septal activation was defined when the earliest right atrial activation occurred at the His bundle region or CS ostium ≥10 milliseconds before P-wave onset.

Results: Among 227 patients (mean age 54.8 ± 15.8 years; 61.7% female), foci were diverse and included: right perinodal, n = 61 (26.9%); septal tricuspid annulus, n = 23 (10.1%); right septum, n = 28 (12.3%); CS ostium, n = 43 (18.9%); left septum, n = 28 (12.3%); septal mitral annulus, n = 16 (7.1%); aorto-mitral continuity, n = 19 (8.4%); and NCC adjacent, n = 9 (4%). Ablation was attempted in 213 (93.8%) of 227 patients and was successful in 189 (88.7%) of 213 patients; there were no instances of persistent atrioventricular block. The NCC was not a common ablation site. P-wave morphology was characteristic (V₁ was predominantly negative/positive, isoelectric/positive, or isoelectric, 91%) but did not distinguish between these anatomical sites. Sequential and systematic mapping was required to localize earliest activation.

Conclusions: Paraseptal focal ATs arise from diverse but closely related anatomical locations. There is no single site from which ablation is consistently successful. Although some are indeed perinodal and accessible from the NCC, others arise from adjacent structures. Nevertheless, detailed, sequential mapping facilitates safe and effective ablation in most cases.

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隔旁局灶性房性心动过速的定位和消融。

背景：局灶性房性心动过速（AT）可能起源于隔旁区一系列密切相关的解剖部位。目的：本研究旨在确定隔旁局灶性AT的解剖分布，检查其心电图和电生理特征，提出一种定位方法，并报告消融结果。方法：本回顾性单中心研究将隔旁ATs定义为起源于以下解剖部位：右节周区、间隔三尖环、右间隔、冠状窦（CS）口、左间隔、二尖瓣间隔环、主动脉-二尖瓣连续性和邻近的非冠状动脉尖尖（NCC）。当最早的右心房激活发生在p波开始前≥10毫秒时，即被定义为早间隔激活。结果：227例患者(平均年龄54.8±15.8岁；61.7%为女性)，病灶多样，包括：右淋巴结周围，n = 61 (26.9%)；间隔三尖瓣环，n = 23 (10.1%)；右隔膜，n = 28 (12.3%)；CS口，n = 43 (18.9%)；左隔膜，n = 28 (12.3%)；二尖瓣中隔环，16例（7.1%）；主动脉-二尖瓣连续性，n = 19 (8.4%)；与NCC相邻，n = 9（4%）。227例患者中有213例（93.8%）尝试消融，213例患者中有189例（88.7%）成功消融；无持续性房室传导阻滞。NCC不是常见的消融部位。p波形态具有特征性（V1主要为负/正、等电/正或等电，占91%），但无法区分这些解剖部位。需要顺序和系统的映射来定位最早的激活。结论：枕旁局灶性ATs起源于不同但密切相关的解剖位置。没有单一部位的消融总是成功的。虽然有些确实是围壁的，可以从NCC进入，但其他的来自邻近的结构。然而，在大多数情况下，详细、顺序的定位有助于安全有效的消融。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.