Atrial Reentry Tachycardia: Mechanisms and Diagnosis

DOI: https://doi.org/10.30702/ujcvs/23.31(04)/AK059-7478
Keywords: ECG diagnostics, endocardial mapping, stimulation protocol, pharmacological test, differential diagnosis

Abstract

Atrial tachycardia (AT) is a group of arrhythmias that differ in electrophysiological mechanisms and clinical course. There are three main forms of AT: focal AT, macroreentries, and localized reentries also known as “microreentries”. Macroreentries, as a rule, occur in the presence of fibrous changes in the myocardium, for example, in “atrial” cardiomyopathy or as a result of catheter or surgical interventions in the atria. Focal AT can also occur in the absence of structural pathology of the heart.

The aim. To analyze modern ideas about electrophysiological mechanisms and diagnosis of atrial reentry tachycardia.

In our research we used data from the literature as well as findings of our own previous studies. The work analyzed global data on the distribution of various types of AT. The data of electrocardiographic (ECG) diagnosis, electrophysiological methods of diagnosis and pharmacological tests were also analyzed to determine the mechanism of occurrence and course of AT. The main ECG differences of different types and localizations of AT were determined. The diagnostic value of various stimulation protocols in the differential diagnosis of focal and macro-reentrant AT was also analyzed.

Conclusions. Atrial tachycardias with a reentrant mechanism are common in the general population. Differential diagnosis with other types of tachycardia is carried out on the basis of ECG data, the response to adenosine administration, the nature of the response during entrainment, and endocardial, particularly electroanatomical, mapping.

References

  1. Callans DJ. Josephson’s Clinical Cardiac Electrophysiology: Techniques and Interpretation. 6th ed. Walters Kluwer;2020.
  2. Markowitz SM, Thomas G, Liu CF, Cheung JW, Ip JE, Lerman BB. Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation. Arrhythm Electrophysiol Rev. 2019;8(2):131-137. https://doi.org/10.15420/aer.2019.17.2
  3. Rostock T, Drewitz I, Steven D, Hoffmann BA, Salukhe TV, Bock K, et al. Characterization, Mapping, and Catheter Ablation of Recurrent Atrial Tachycardias After Stepwise Ablation of Long-Lasting Persistent Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2010;3(2):160-169. https:// doi.org/10.1161/CIRCEP.109.899021
  4. Wasmer K, Mönnig G, Bittner A, Dechering D, Zellerhoff S, Milberg P, et al. Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation. Heart Rhythm. 2012;9(10):1660-1666. https://doi.org/10.1016/j.hrthm.2012.06.007
  5. Hermida A, Kubala M, Traullé S, Buiciuc O, Quenum S, Hermida JS. Prevalence and predictive factors of left atrial tachycardia occurring after second-generation cryoballoon ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2018;29(1):46-54. https://doi.org/10.1111/jce.13364
  6. Granada J, Uribe W, Chyou PH, Maassen K, Vierkant R, Smith PN, et al. Incidence and predictors of atrial flutter in the general population. J Am Coll Cardiol. 2000;36(7):2242-2246. https://doi.org/10.1016/s0735-1097(00)00982-7
  7. Pascale P, Roten L, Shah AJ, Scherr D, Komatsu Y, Ramoul K, et al. Useful Electrocardiographic Features to Help Identify the Mechanism of Atrial Tachycardia Occurring After Persistent Atrial Fibrillation Ablation. JACC Clin Electrophysiol. 2018;4(1):33-45. https://doi.org/10.1016/j.jacep.2017.07.018
  8. Vollmann D, Stevenson WG, Lüthje L, Sohns C, John RM, Zabel M, et al. Misleading Long Post-Pacing Interval After Entrainment of Typical Atrial Flutter From the Cavotricuspid Isthmus. J Am Coll Cardiol. 2012;59(9):819-824. https://doi.org/10.1016/j.jacc.2011.11.023
  9. Barbhaiya CR, Baldinger SH, Kumar S, Chinitz JS, Enriquez AD, John R, et al. Downstream overdrive pacing and intracardiac concealed fusion to guide rapid identification of atrial tachycardia after atrial fibrillation ablation. Europace. 2018;20(4):596-603. https://doi.org/10.1093/europace/euw405
  10. Cosío FG. Atrial Flutter, Typical and Atypical: A Review. Arrhythm Electrophysiol Rev. 2017;6(2):55-62. https://doi.org/10.15420/aer.2017.5.2
  11. Yang JD, Sun Q, Guo XG, Zhou GB, Liu X, Luo B, et al. Right atrial dual-loop reentrant tachycardia after cardiac surgery: Prevalence, electrophysiological characteristics, and ablation outcomes. Heart Rhythm. 2018;15(8):1148-1157. https://doi.org/10.1016/j.hrthm.2018.03.039
  12. Selvaraj R, Theodore J. Upper loop re-entrant flutter. Europace. 2019;21(8):1192. https://doi.org/10.1093/europace/euz173
  13. Moore BM, Anderson R, Nisbet AM, Kalla M, du Plessis K, d’Udekem Y, et al. Ablation of Atrial Arrhythmias After the Atriopulmonary Fontan Procedure: Mechanisms of Arrhythmia and Outcomes. JACC Clin Electrophysiol. 2018;4(10):1338-1346. https://doi.org/10.1016/j.jacep.2018.08.012
  14. Kamp AN, Nair K, Fish FA, Khairy P. Catheter Ablation of Atrial Arrhythmias in Patients Post-Fontan. Can J Cardiol. 2022;38(7):1036-1047. https://doi.org/10.1016/j.cjca.2022.02.023
  15. Takigawa M, Derval N, Frontera A, Martin R, Yamashita S, Cheniti G, et al. Revisiting anatomic macroreentrant tachycardia after atrial fibrillation ablation using ultrahigh-resolution mapping: Implications for ablation. Heart Rhythm. 2018;15(3):326-333. https://doi.org/10.1016/j.hrthm.2017.10.029
  16. Wong MC, Kalman JM, Ling LH, Medi C, Teh A, Lee G, et al. Left Septal Atrial Tachycardias: Electrocardiographic and Electrophysiologic Characterization of a Paraseptal Focus. J Cardiovasc Electrophysiol. 2013;24(4):413-418. https://doi.org/10.1111/jce.12049
  17. Frontera A, Mahajan R, Dallet C, Vlachos K, Kitamura T, Takigawa M, et al. Characterizing localized reentry with high-resolution mapping: Evidence for multiple slow conducting isthmuses within the circuit. Heart Rhythm. 2019;16(5):679-685. https://doi.org/10.1016/j.hrthm.2018.11.027
  18. Markowitz SM, Nemirovksy D, Stein KM, Mittal S, Iwai S, Shah BK, et al. Adenosine-insensitive focal atrial tachycardia: evidence for de novo micro-re-entry in the human atrium. J Am Coll Cardiol. 2007;49(12):1324-1333. https://doi.org/10.1016/j.jacc.2006.11.037
Published
2023-12-28
How to Cite
1.
Almiz PO, Kravchuk BB. Atrial Reentry Tachycardia: Mechanisms and Diagnosis. ujcvs [Internet]. 2023Dec.28 [cited 2024Dec.26];31(4):74-8. Available from: https://cvs.org.ua/index.php/ujcvs/article/view/609
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 31 No 4 2023
Section
HEART RHYTHM DISORDER

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