Author + information
- Received August 30, 2018
- Revision received January 15, 2019
- Accepted January 18, 2019
- Published online March 27, 2019.
- Gwilym M. Morris, BmBCh, PhDa,b,
- Louise Segan, MBBSa,
- Geoff Wong, MBBSa,
- Gareth Wynn, MBChB, MD(Res)a,
- Troy Watts, BSca,
- Patrick Heck, BmBCh, DMa,
- Tomos E. Walters, MBBS, PhDa,
- Ashley Nisbet, MBChB, PhDa,
- Paul Sparks, MBBS, PhDa,
- Joseph B. Morton, MBBS, PhDa,
- Peter M. Kistler, MBBS, PhDc,d,e and
- Jonathan M. Kalman, MBBS, PhDa,c,∗ ()
- aDepartment of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- bDivision of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- cFaculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- dDepartment of Cardiology, The Alfred Hospital, Melbourne, Australia
- eBaker IDI Heart and Diabetes Institute, Melbourne, Australia
- ↵∗Address for correspondence:
Dr. Jonathan M. Kalman, Department of Cardiology, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria–3050, Australia.
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.
Dr. Morris is supported by a British Heart Foundation Intermediate Fellowship. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. William Steveson, MD, served as Guest Editor for this paper.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received August 30, 2018.
- Revision received January 15, 2019.
- Accepted January 18, 2019.
- 2019 American College of Cardiology Foundation
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