Ablation Therapy of Supraventricular Tachycardia in Elderly Persons

Leonard S. Dreifus, MD; Scott J. Pollak, MD

Disclosures

Am J Geriatr Cardiol. 2005;14(1):20-25. 

In This Article

Focal And Nonparoxysmal Junctional Tachycardia

Although the most frequently occurring varieties of AV tachycardia described previously are paroxysmal in the mode of their onset and offset, a less frequently observed type of accelerated junctional tachycardia (nonparoxysmal nodal tachycardia) occurs in the absence of structural heart disease and is often associated with digitalis excess, acute myocardial infarction, cardiac surgery, and hypokalemia.[10,11]

The electrophysiologic mechanism may be due to either enhanced automaticity or triggered activity. In contrast to the paroxysmal variety, the nonparoxysmal type develops gradually and disappears slowly. The rate of these tachycardias usually exceeds 70 bpm. Figure 4 illustrates an example of nonparoxysmal junctional tachycardia. Note the gradual onset of the junctional mechanism as the sinus cycle length increases from 635-670 milliseconds while the ectopic rhythm usurps the sinus rhythm at a more rapid cycle length of 610 milliseconds. Figure 5 describes the CARTO map in the RAO projection. The right atrial electrogram tag identifies the site of earliest retrograde atrial activation during the tachycardia. However, the catheter icon (sinoatrial) identifies the site of successful ablation of the tachycardia. The value of the electroanatomical mapping was seen in this case to be 2.16 cm between the earliest site of retrograde atrial activation and the successful ablation site. In elderly persons, management of atrial arrhythmias, especially atrial fibrillation, continues to be associated with major morbidity, mortality, frequent hospitalization, and high health costs. Newer antiarrhythmic agents are more successful and less toxic than quinidine or procainamide, but still are associated with major side effects.

Electrocardiogram showing nonparoxysmal junctional tachycardia. Note the gradual onset of the junctional mechanism as the sinus cycle length increases from 635 to 670 milliseconds while the ectopic rhythm usurps the sinus rhythm at a more rapid cycle length of 610 milliseconds.

Carto (Biosense Webster, Diamond Bar, CA) map in the right anterior oblique projection. PH=proximal His; RCS=roof of coronary sinus; Suc AB=successful ablation; FCS=floor of coronary sinus.

The development of ablative techniques can offer patients a permanent cure as well as freedom from troublesome antiarrhythmic drugs. Ablative technology and innovative mapping procedures are still evolving.

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