Advertisement

Potential anatomic substrate of peri-atrioventricular nodal atrial tachycardia ablated from the noncoronary sinus of Valsalva

  • Hiroaki Mano
  • Yasuo Okumura
  • Ichiro Watanabe
  • Naoko Sasaki
  • Rikitake Kogawa
  • Kazumasa Sonoda
  • Koichi Nagashima
  • Hironori Haruta
  • Masayoshi Kofune
  • Kimie Ohkubo
  • Toshiko Nakai
  • Atsushi Hirayama
Article

Abstract

Introduction

Although focal atrial tachycardia (AT) is known to sometimes be ablated from the noncoronary aortic cusp (NCC), the electro-anatomic characteristics of NCC-AT are not well known.

Methods

We compared the clinical, 12-lead electrocardiogram (ECG), and transthoracic echocardiogram characteristics of 6 women (median age, 66.5 years) with NCC-AT and 12 age-matched women (median age, 64.0 years) with atrioventricular nodal reentrant tachycardia (AVNRT) as the control group.

Results

There was no difference in the prevalence of hypertension between the two groups (67 vs. 33 %, respectively, P = 0.3213). The resting ECG of the NCC-AT group vs. that of the AVNRT group showed a significantly longer PQ interval (170.0 (interquartile range (IQR), 157.5–180.0 ms) vs. 140.0 ms (IQR, 122.5–147.5 ms), P = 0.0010) and leftward shifting of the QRS axis (4° (IQR, −26.0° to 24.0°) vs. 57° (IQR, 43.0–70.2°), P = 0.0087). The upper interventricular septum (IVS) thickness was significantly greater (15.6 (IQR, 11.9–18.7 ms) vs. 11.7 mm (IQR, 10.2–12.9 ms), P = 0.0393), and the angle formed by the aortic roof and IVS (AS angle) was significantly steeper (103.0° (IQR, 94.2–119.2°) vs. 122.5° (IQR, 108.5–128.5°), P = 0.0343) in the NCC-AT group than in the AVNRT group.

Conclusions

Our data suggest that NCC-AT is characterized by a longer atrioventricular (AV) conduction time, steeper AS angle, and thicker IVS than are seen with AVNRT. These electrocardiographic and echocardiographic characteristics from the IVS to the peri-AV nodal regions may have some effect on the development of NCC-AT.

Keywords

Atrial tachycardia Noncoronary aortic cusp Electrocardiography Echocardiography 

Notes

Funding

Funding of this study includes departmental resources only.

Conflict of interest

None

References

  1. 1.
    Klersy, C., Chimienti, M., Marangoni, E., Comelli, M., & Salerno, J. A. (1993). Factors that predict spontaneous remission of ectopic atrial tachycardia. European Heart Journal, 14, 1654–1656.PubMedCrossRefGoogle Scholar
  2. 2.
    Whaton, M., Shenasa, H., Barold, H., Simons, G., & Vergara, I. (2000). Ablation of atrial tachycardia in adults. In S. K. S. Huang & D. J. Wilber (Eds.), Radiofrequency catheter ablation of cardiac arrhythmias: basic concepts and clinical applications (pp. 139–163). New York: Futura Publishing.Google Scholar
  3. 3.
    Ouyang, F., Ma, J., Ho, S. Y., Bänsch, D., Schmidt, B., Ernst, S., et al. (2006). Focal atrial tachycardia originating from the non-coronary aortic sinus: electrophysiological characteristics and catheter ablation. Journal of the American College of Cardiology, 48, 122–131.PubMedCrossRefGoogle Scholar
  4. 4.
    Das, S., Neuzil, P., Albert, C. M., D'Avila, A., Mansour, M., Mela, T., et al. (2008). Catheter ablation of peri-AV nodal atrial tachycardia from the noncoronary cusp of the aortic valve. Journal of Cardiovascular Electrophysiology, 19, 231–237.PubMedCrossRefGoogle Scholar
  5. 5.
    Zhou, Y. F., Wang, Y., Zeng, Y. J., Li, X. L., Zheng, J. G., Yang, P., et al. (2010). Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from non-coronary sinuses of Valsalva in the aorta. Journal of Interventional Cardiac Electrophysiology, 28, 147–151.PubMedCrossRefGoogle Scholar
  6. 6.
    Wang, Z., Liu, T., Shehata, M., Liang, Y., Jin, Z., Liang, M., et al. (2011). Electrophysiological characteristics of focal atrial tachycardia surrounding the aortic coronary cusps. Circulation. Arrhythmia and Electrophysiology, 4, 902–908.PubMedCrossRefGoogle Scholar
  7. 7.
    Chen, S. A., Wu, T. J., Chiang, C. E., Tai, C. T., Chiou, C. W., Ueng, K. C., et al. (1995). Recurrent tachycardia after selective ablation of slow pathway in patients with atrioventricular nodal reentrant tachycardia. The American Journal of Cardiology, 76, 131–137.PubMedCrossRefGoogle Scholar
  8. 8.
    Tai, C. T., Chen, S. A., Chiang, C. E., Lee, S. H., Wen, Z. C., Chiou, C. W., et al. (1997). Complex electrophysiological characteristics in atrioventricular nodal reentrant tachycardia with continuous atrioventricular node function curves. Circulation, 95, 2541–2547.PubMedCrossRefGoogle Scholar
  9. 9.
    Zipes, D. P., Jalife, J., Otomo, K., Wang, Z., Lazarra, R., & Jackman, W. M. (1999). Atrioventricular nodal reentrant tachycardia: electrophysiological characteristics of four forms and implications for the reentrant circuit. In D. P. Zipes & J. Jalife (Eds.), Cardiac electrophysiology: from cell to bedside (3rd ed., pp. 504–521). Philadelphia: Saunders.Google Scholar
  10. 10.
    Iesaka, Y., Takahashi, A., Goya, M., Soejima, Y., Okamoto, Y., Fujiwara, H., et al. (1997). Adenosine-sensitive atrial reentrant tachycardia originating from the atrioventricular nodal transitional area. Journal of Cardiovascular Electrophysiology, 8, 854–864.PubMedCrossRefGoogle Scholar
  11. 11.
    Josephson, M. E., & Wellens, H. J. (1990). Differential diagnosis of supraventricular tachycardia. Cardiology Clinics, 8, 411–442.PubMedGoogle Scholar
  12. 12.
    Knight, B. P., Ebinger, M., Oral, H., Kim, M. H., Sticherling, C., Pelosi, F., et al. (2000). Diagnostic value of tachycardia features and pacing maneuvers during paroxysmal supraventricular tachycardia. Journal of the American College of Cardiology, 36, 574–582.PubMedCrossRefGoogle Scholar
  13. 13.
    Marrouche, N. F., SippensGroenewegen, A., Yang, Y., Dibs, S., & Scheinman, M. M. (2002). Clinical and electrophysiologic characteristics of left septal atrial tachycardia. Journal of the American College of Cardiology, 40, 1133–1139.PubMedCrossRefGoogle Scholar
  14. 14.
    Maruyama, M., Kobayashi, Y., Miyauchi, Y., Ino, T., Atarashi, H., Katoh, T., et al. (2007). The VA relationship after differential atrial overdrive pacing: a novel tool for the diagnosis of atrial tachycardia in the electrophysiologic laboratory. Journal of Cardiovascular Electrophysiology, 18, 1127–1133.PubMedCrossRefGoogle Scholar
  15. 15.
    Kitchin, A. H., & Milne, J. S. (1997). Longitudinal survey of ischaemic heart disease in randomly selected sample of older population. British Heart Journal, 39, 889–893.CrossRefGoogle Scholar
  16. 16.
    Gorman, P. A., Calatayud, J. B., Abraham, S., & Caceres, C. A. (1964). Effects of age and heart disease on the QRS axis during the seventh through tenth decades. American Heart Journal, 67, 39–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Yasumura, S., & Shibata, H. (1989). The effect of aging on the electrocardiographic findings in the elderly a 10-year longitudinal study: the Koganei Study. Archives of Gerontology and Geriatrics, 9, 1–15.PubMedCrossRefGoogle Scholar
  18. 18.
    Daiz, T., Pencina, M. J., Benjamin, E. J., Aragam, J., Fuller, D. L., Pencina, K. M., et al. (2009). Prevalence, clinical correlates and prognosis of discrete upper septal thickening on echocardiography: the Framingham Heart Study. Echocardiography, 26, 247–253.CrossRefGoogle Scholar
  19. 19.
    Bolca, O., Özer, N., Eren, M., Dağdeviren, B., Norgaz, T., Akdemir, O., et al. (2002). Dobutamine induced dynamic left ventricular outflow tract obstruction in patients with hypertrophic nonobstructive cardiomyopathy. The Tohoku Journal of Experimental Medicine, 198, 79–87.PubMedCrossRefGoogle Scholar
  20. 20.
    Goor, D., Lillehei, C. W., & Edwards, J. E. (1969). The “sigmoid septum”. Variation in the contour of the left ventricular outlet. The American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine, 107, 366–376.PubMedCrossRefGoogle Scholar
  21. 21.
    Waller, B. F. (1988). The old-age heart: Normal aging changes which can produce or mimic cardiac disease. Clinical Cardiology, 11, 513–517.PubMedCrossRefGoogle Scholar
  22. 22.
    Waller, B. F., & Roberts, W. C. (1983). Cardiovascular disease in the very elderly. Analysis of 40 necropsy patients aged 90 years or over. The American Journal of Cardiology, 51, 403–421.PubMedCrossRefGoogle Scholar
  23. 23.
    Liu, X., Dong, J., Ho, S. Y., Shah, A., Long, D., Yu, R., et al. (2010). Atrial tachycardia arising adjacent to noncoronary aortic sinus: distinctive atrial activation patterns and anatomic insights. Journal of the American College of Cardiology, 56, 796–804.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Hiroaki Mano
    • 1
  • Yasuo Okumura
    • 1
  • Ichiro Watanabe
    • 1
  • Naoko Sasaki
    • 1
  • Rikitake Kogawa
    • 1
  • Kazumasa Sonoda
    • 1
  • Koichi Nagashima
    • 1
  • Hironori Haruta
    • 1
  • Masayoshi Kofune
    • 1
  • Kimie Ohkubo
    • 1
  • Toshiko Nakai
    • 1
  • Atsushi Hirayama
    • 1
  1. 1.Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan

Personalised recommendations