Electrophysiologic and pharmacologic characteristics of automatic ectopic atrial tachycardia.

Gillette, Paul C.; Garson, Arthur

doi:10.1161/01.cir.56.4.571

Cited by 205 publications

(45 citation statements)

References 24 publications

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“…If conduction time to the circuit were considered reentry.' The phenomenon of resetting was originally described for the sinus node and automatic rhythms.2' 15, 16 However, it is well known that in the best human model of reentry, circus-movement tachycardia incorporating an atrioventricular bypass tract, premature extrastimuli can result in resetting of the tachycardia. 17 In the present discussion we will assume that the same mechanism, i.e., premature penetration of the circuit advancing the activation within the circuit explain an increasing response pattern or an increasing zone in a mixed response pattern (figure 7): (1) Conduction delay of the paced impulse between the pacing site and the circuit.…”

Section: Resultsmentioning

confidence: 99%

Resetting response patterns during sustained ventricular tachycardia: relationship to the excitable gap.

et al. 1986

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We analyzed the resetting response (a noncompensatory pause after electrical stimulation) during 37 hemodynamically tolerated ventricular tachycardias (VTs) induced by programmed electrical stimulation in 32 patients with chronic coronary artery disease. dence and "requirements" of resetting of VT have been described.56 The phenomenon of continuous resetting (i.e., entrainment) has also been described.4' -11 However, no systematic analysis of the pattern of the resetting response (i.e., the relationship of the timing of the first tachycardia beat following resetting stimuli and coupling intervals of the premature stimuli producing resetting) during a large number of VTs is available.

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Section: Resultsmentioning

confidence: 99%

Resetting response patterns during sustained ventricular tachycardia: relationship to the excitable gap.

et al. 1986

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“…The diagnosis of FAT was based on ECG, 24-hour Holter, or event monitor data consistent with electrophysiological criteria previously described 1,17 : (1) narrow complex tachycardia with visible P waves at a rate inappropriate for age and activity, (2) identical abnormal P-wave morphology in the first and all subsequent tachycardia beats, (3) progressive increase in atrial rate with tachycardia onset (warm-up), (4) variable rate depending on autonomic tone, and (5) first-or second-degree atrioventricular block in the presence of continued tachycardia ( Figure 1). Features that help distinguish FAT from sinus tachycardia include: (1) routine ECG atrial rate >150% of the predicted mean, (2) inverted and notched P wave in V1, (3) P-wave axis in the horizontal plane <0°, and (4) P-wave duration >90 ms in V1.…”

Section: Patient Populationmentioning

confidence: 99%

“…[1][2][3] FAT often occurs as an incessant arrhythmia. The natural history includes possible progression to tachycardia-induced cardiomyopathy, which is reversible with control of the arrhythmia.…”

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confidence: 99%

Current Management of Focal Atrial Tachycardia in Children

Kang

Etheridge

Kantoch

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background— Focal atrial tachycardia (FAT) is an uncommon cause of supraventricular tachycardia in children. Incessant FAT can lead to tachycardia-induced cardiomyopathy. There is limited information regarding the clinical course and management of FAT. This study characterizes current management strategies for FAT in children including the prevalence of spontaneous resolution and the role of catheter ablation. Methods and Results— This is a retrospective chart review of pediatric patients with FAT managed between January 2000 and November 2010 at 10 pediatric centers. There were 249 patients with a median age at diagnosis of 7.2 (95% confidence interval, 5.8–10.4) years. Cardiomyopathy was observed in 28%. Resolution of FAT occurred in 89%, including spontaneous resolution without catheter ablation in 34%. Antiarrhythmic medications were used for initial therapy in 154 patients with control of FAT in 72%. Among first-line medications, β-blockers were the most common (53%) and effective (42%). Catheter ablation was successful in 80% of patients. FAT recurrence was less common with electroanatomic mapping compared with conventional mapping techniques (16% versus 35%; P =0.02). Patients were followed for a median of 2.1 (95% confidence interval, 1.8–2.6) years. Conclusions— FAT is managed successfully in most children. Current approaches are variable. Many patients have control of FAT with medications; however, catheter ablation is used for most patients. Spontaneous resolution is common for young children, emphasizing the role for delayed ablation in this group. Ablation is successful for all ages. Lower recurrence occurs when electroanatomic mapping techniques are used.

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“…This could lead to an underestimation of the incidence of this phenomenon. Equipment capable of recording 12 simultaneous surface leads would have to be used or trains of multiple extrastimuli would have to be utilized to entrain the VT instead of single or double extrastimuli.…”

Section: Discussionmentioning

confidence: 99%

Resetting of ventricular tachycardia with electrocardiographic fusion: incidence and significance.

et al. 1988

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The incidence and significance of fusion of the QRS complex during resetting of sustained ventricular tachycardias (VTs) was determined in 53 VTs induced by programmed stimulation in 46 patients with prior myocardial infarction. All 53 VTs were reset with one or two extrastimuli delivered at the right ventricular apex (RVA); 29 (54.7%) demonstrated fusion of the VT QRS complex coincident with the extrastimulus resetting the VT. Activation time at the RVA during VT (measured from the onset of the VT QRS complex to the first rapid deflection of the RVA electrogram) was longer in VT reset with fusion compared with those without fusion (91 + 30 vs 33 + 32 msec; p < .001). A right bundle branch block VT QRS morphology and a rightward and inferior axis were more common in VT reset with electrocardiographic (ECG) fusion. Additionally, the shortest return cycle following the extrastimulus resetting the VT was shorter in VT reset with ECG fusion compared with those without (327 + 66 vs 423 84 msec; p < .001). Fusion of the endocardial electrogram recorded at the site of VT origin was noted in 11 of 15 VTs that were reset while a recording catheter was positioned at this site, including all eight VTs with evidence of surface ECG fusion and three of seven VTs without fusion. Seventeen VTs were reset from the right ventricular outflow tract as well as the RVA; eight demonstrated QRS fusion at both sites, five from the right ventricular outflow tract only, and four from neither site. In conclusion (1) the phenomenon of resetting of sustained VT with concomitant fusion on the surface ECG and on endocardial electrograms recorded from the site of VT origin is common and is most consistent with a reentrant mechanism with separate entrance and exit sites in the reentrant VT circuit; (2) the proximity of the pacing site to the exit site of the VT circuit is a major determinant of ECG fusion during resetting; and (3) because of the shorter return cycles during VT resetting with ECG fusion, it is postulated that such VTs are likely to have more widely separated entrance and exit sites in the reentrant circuit than VTs reset without fusion. Circulation 77, No. 3, 581-588, 1988. SUSTAINED uniform ventricular tachycardia (VT) occurring in the setting of prior myocardial infarction has been thought to be due to a reentrant mechanism. 1-3

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Electrophysiologic and pharmacologic characteristics of automatic ectopic atrial tachycardia.

Cited by 205 publications

References 24 publications

Resetting response patterns during sustained ventricular tachycardia: relationship to the excitable gap.

Resetting response patterns during sustained ventricular tachycardia: relationship to the excitable gap.

Current Management of Focal Atrial Tachycardia in Children

Resetting of ventricular tachycardia with electrocardiographic fusion: incidence and significance.

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