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Tale of two tails: The tip of the atrial appendages is an unusual site for focal atrial tachycardia

2006; Elsevier BV; Volume: 3; Issue: 4 Linguagem: Inglês

10.1016/j.hrthm.2005.12.013

1556-3871

Richard J. Hillock, Suresh Singarayar, Jonathan M. Kalman, Paul Sparks,

Cardiac pacing and defibrillation studies

Focal atrial tachycardias arise predominantly from a small number of atrial anatomic structures. 1 Kistler P.M. Sanders P. Fynn S.P. Stevenson I.H. Hussin A. Vohra J.K. Sparks P.B. Kalman J.M. Electrophysiological and electrocardiographic characteristics of focal atrial tachycardia originating from the pulmonary veins acute and long-term outcomes of radiofrequency ablation. Circulation. 2003; 16: 1968-1975 Crossref Scopus (165) Google Scholar , 2 Morton J.B. Sanders P. Das A. Vohra J.K. Sparks P.B. Kalman J.M. Focal atrial tachycardia arising from the tricuspid annulus electrophysiologic and electrocardiographic characteristics. J Cardiovasc Electrophysiol. 2001; 12: 653-659 Crossref PubMed Scopus (134) Google Scholar , 3 Kistler P.M. Sanders P. Hussin A. Morton J.B. Vohra J.K. Sparks P.B. Kalman J.M. Focal atrial tachycardia arising from the mitral annulus electrocardiographic and electrophysiologic characterization. J Am Coll Cardiol. 2003; 41: 2212-2219 Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar Atrial tachycardias originating from the atrial appendages are uncommon in normal atria and usually arise from the mouth (base). 4 Lesh M.D. Van Hare G.F. Epstein L.M. Fitzpatrick A.P. Scheinman M.M. Lee R.J. Kwasman M.A. Grogin H.R. Griffin J.C. Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms. Circulation. 1994; 89: 1074-1089 Crossref PubMed Scopus (450) Google Scholar , 5 Tang C.W. Scheinman M.M. Van Hare G.F. Epstein L.M. Fitzpatrick A.P. Lee R.J. Lesh M.D. Use of P wave configuration during atrial tachycardia to predict site of origin. J Am Coll Cardiol. 1995; 26: 1315-1324 Abstract Full Text PDF PubMed Scopus (244) Google Scholar Rare instances of atrial tachycardias in association with aneurysms of the atrial appendages 6 Chockalingam A. Alagesan R. Nandakumar M. Gnanavelu G. Massive left atrial appendage aneurysm presenting as supraventricular tachycardia. Indian Heart J. 2003; 55: 379-381 PubMed Google Scholar , 7 Wagshal A.B. Applebaum A. Crystal P. Goldfarb B. Erez A. Tager S. Katz A. Atrial tachycardia as the presenting sign of a left atrial appendage aneurysm. Pacing Clin Electrophysiol. 2000; 23: 283-285 Crossref PubMed Scopus (19) Google Scholar , 8 Mizui S. Mori K. Kuroda Y. Ectopic atrial tachycardia due to aneurysm of the right atrial appendage. Cardiol Young. 2001; 11: 229-232 Crossref PubMed Google Scholar and venous anomalies overlying the left atrial appendage structure have been described. 9 Tse H.F. Lau C.P. Lee K.L. Morady F. Atrial tachycardia arising from an epicardial site with venous connection between the left superior pulmonary vein and superior vena cava. J Cardiovasc Electrophysiol. 2003; 14: 540-543 Crossref PubMed Scopus (5) Google Scholar Although atrial appendage resection has been described as a curative procedure, 10 Graffigna A. Vigano M. Pagani F. Salerno G. Surgical treatment for ectopic atrial tachycardia. Ann Thorac Surg. 1992; 54: 338-343 Abstract Full Text PDF PubMed Scopus (13) Google Scholar , 11 Wyndham C.R. Arnsdorf M.F. Levitsky S. Smith T.C. Dhingra R.C. Denes P. Rosen K.M. Successful surgical excision of focal paroxysmal atrial tachycardia. Observations in vivo and in vitro. Circulation. 1980; 62: 1365-1372 Crossref PubMed Scopus (101) Google Scholar focal atrial tachycardias arising from the distal tip of the atrial appendages successfully treated by radiofrequency (RF) ablation have not been reported.