Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method
Background The anatomical tachycardia circuit of sinoatrial node reentrant tachycardia (SANRT) has not been well clarified. This study aimed to elucidate the tachycardia circuit of SANRT. Methods and Results Exit and entrance of the intranodal sinoatrial node conduction (I‐SANC) of the reentry circu...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.014472 |
| _version_ | 1831812615243825152 |
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| author | Hiroshige Yamabe Yoshiya Orita |
| author_facet | Hiroshige Yamabe Yoshiya Orita |
| author_sort | Hiroshige Yamabe |
| collection | DOAJ |
| description | Background The anatomical tachycardia circuit of sinoatrial node reentrant tachycardia (SANRT) has not been well clarified. This study aimed to elucidate the tachycardia circuit of SANRT. Methods and Results Exit and entrance of the intranodal sinoatrial node conduction (I‐SANC) of the reentry circuit were identified in 15 SANRT patients. After identifying the earliest atrial activation site (EAAS) during the tachycardia (EAAS‐SANRT), rapid atrial pacing was delivered from multiple atrial sites to identify the entrainment pacing site where manifest entrainment and orthodromic capture of the EAAS‐SANRT were demonstrated. Radiofrequency energy was then delivered starting at a site 2 cm proximal to the EAAS‐SANRT in the direction of the entrainment pacing site and gradually advanced toward the EAAS‐SANRT until tachycardia termination to localize the I‐SANC entrance. The EAAS‐SANRT was orthodromically captured by pacing delivered from the distal coronary sinus (n=7), high posteroseptal right atrium (n=2), low posteroseptal right atrium (n=2), low anterolateral right atrium (n=2), or coronary sinus ostium (n=2). Radiofrequency energy delivery to the entrance of the I‐SANC, 10.4±2.8 mm away from the EAAS‐SANRT, terminated tachycardia immediately after onset of energy delivery (3.4±2.3 seconds). The successful ablation site was located further from the EAAS during sinus rhythm (EAAS‐sinus) than the EAAS‐SANRT (12.8±4.5 versus 7.2±3.1 mm; P<0.0001). Conclusions The reentry circuit of SANRT was composed of the entrance and exit of the I‐SANC being located at distinctly different anatomical sites. SANRT was eliminated by radiofrequency energy delivered to the I‐SANC entrance, which was further from the EAAS‐sinus than I‐SANC exit. |
| first_indexed | 2024-12-22T21:39:27Z |
| format | Article |
| id | doaj.art-445f2e1555c34f76a89bc1bd33475b40 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:39:27Z |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-445f2e1555c34f76a89bc1bd33475b402022-12-21T18:11:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-01-019210.1161/JAHA.119.014472Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment MethodHiroshige Yamabe0Yoshiya Orita1Department of Cardiology Cardiovascular Center Shin‐Koga Hospital Kurume City JapanDepartment of Cardiology Cardiovascular Center Shin‐Koga Hospital Kurume City JapanBackground The anatomical tachycardia circuit of sinoatrial node reentrant tachycardia (SANRT) has not been well clarified. This study aimed to elucidate the tachycardia circuit of SANRT. Methods and Results Exit and entrance of the intranodal sinoatrial node conduction (I‐SANC) of the reentry circuit were identified in 15 SANRT patients. After identifying the earliest atrial activation site (EAAS) during the tachycardia (EAAS‐SANRT), rapid atrial pacing was delivered from multiple atrial sites to identify the entrainment pacing site where manifest entrainment and orthodromic capture of the EAAS‐SANRT were demonstrated. Radiofrequency energy was then delivered starting at a site 2 cm proximal to the EAAS‐SANRT in the direction of the entrainment pacing site and gradually advanced toward the EAAS‐SANRT until tachycardia termination to localize the I‐SANC entrance. The EAAS‐SANRT was orthodromically captured by pacing delivered from the distal coronary sinus (n=7), high posteroseptal right atrium (n=2), low posteroseptal right atrium (n=2), low anterolateral right atrium (n=2), or coronary sinus ostium (n=2). Radiofrequency energy delivery to the entrance of the I‐SANC, 10.4±2.8 mm away from the EAAS‐SANRT, terminated tachycardia immediately after onset of energy delivery (3.4±2.3 seconds). The successful ablation site was located further from the EAAS during sinus rhythm (EAAS‐sinus) than the EAAS‐SANRT (12.8±4.5 versus 7.2±3.1 mm; P<0.0001). Conclusions The reentry circuit of SANRT was composed of the entrance and exit of the I‐SANC being located at distinctly different anatomical sites. SANRT was eliminated by radiofrequency energy delivered to the I‐SANC entrance, which was further from the EAAS‐sinus than I‐SANC exit.https://www.ahajournals.org/doi/10.1161/JAHA.119.014472atrial tachycardiacatheter ablationmapping |
| spellingShingle | Hiroshige Yamabe Yoshiya Orita Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial tachycardia catheter ablation mapping |
| title | Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method |
| title_full | Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method |
| title_fullStr | Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method |
| title_full_unstemmed | Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method |
| title_short | Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method |
| title_sort | demonstration of the anatomical tachycardia circuit in sinoatrial node reentrant tachycardia analysis using the entrainment method |
| topic | atrial tachycardia catheter ablation mapping |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.014472 |
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