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박예민,최종일,김우현,이손기,임홍의,박상원,김영훈,국형돈 대한심장학회 2013 Korean Circulation Journal Vol.43 No.1
Background and Objectives: The sinus venosus (SV) is not a well known source of atrial tachycardia (AT), but it can harbor AT during cathe-ter ablation of atrial fibrillation (AF). Subjects and Methods: A total of 1223 patients who underwent catheter ablation for AF were reviewed. Electrophysiological and elec-trocardiographic characteristics and outcomes after catheter ablation of AT originating from the SV were investigated. Results: Ten patients (0.82%) demonstrated AT from the SV (7 males, 53.9±16.0 years, 6 persistent) during ablation of AF. The mean cycle length was 281±73 ms. After pulmonary vein isolation and left atrial ablation, AF converted to AT from the SV during right atrial ablation in 2 patients, by rapid atrial pacing after AF termination in 7 patients, and during isoproterenol infusion in 1 patient. Positive P-waves in in-ferior leads were shown in most patients (90%). The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80±37 ms during AT. Using 4.4±2.7 radiofrequency focal applica-tions, ATs were terminated and became no longer inducible in all. After ablation procedure, two patients showed transient right phrenic nerve palsy. After 19.9±14.8 months, all but 1 patient were free of atrial tachyarrhythmia without complications. Conclusion: The AT which develops during AF ablation is rarely originated from SV, and its electrophysiologic characteristics may be help-ful in guiding effective focal ablation.
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