Long-term effectiveness of surgical treatment of ectopic atrial tachycardia.

Abstract

OBJECTIVES:

The purpose of this study was to determine the long-term clinical outcome of patients with ectopic atrial tachycardias treated surgically.

BACKGROUND:

Ectopic atrial tachycardia is an uncommon arrhythmia that can be symptomatic and is associated with the development of a cardiomyopathy. Management strategies are not well defined because of the paucity of data on the long-term effectiveness of pharmacologic and nonpharmacologic therapies.

METHODS:

The long-term clinical impact of medical and surgical therapy was determined in 15 consecutive patients with ectopic atrial tachycardia. All 15 patients were initially treated with antiarrhythmic drugs (mean 5.7 +/- 2.2 drugs/patient). An effective drug regimen was identified in only 5 (33%) of the 15 patients; the remaining 10 patients were treated surgically. In each, individualized surgical procedures were guided by computer-assisted intraoperative mapping, with atrial plaques comprising up to 156 electrodes. Focal ablation was performed in four patients and atrial isolation procedures in six.

RESULTS:

The 10 patients treated surgically were followed up a mean of 4 +/- 3.2 years. Ectopic atrial tachycardia recurred in one patient. A permanent pacemaker was implanted in two patients, one of whom also required reoperation for constrictive pericarditis. There were no operative deaths. Ectopic atrial tachycardia recurred in three (60%) of the five patients discharged on antiarrhythmic drug therapy during a mean follow-up interval of 6.4 +/- 4.3 years. There was one nonarrhythmic death.

CONCLUSIONS:

Map-guided surgery demonstrated long-term efficacy in abolishing symptoms in 9 of the 10 patients with ectopic atrial tachycardia. Results demonstrate that surgery is effective for patients with ectopic atrial tachycardias who are not easily treated with antiarrhythmic drugs.

• Authors: N A Prager, J L Cox, B D Lindsay, T B Ferguson Jr, J L Osborn, M E Cain
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 22 Issue 1 Pg. 85-92 (Jul 1993) ISSN: 0735-1097 [Print] United States
• PMID: 8509569 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Anti-Arrhythmia Agents

Topics

• Adolescent
• Adult
• Aged
• Anti-Arrhythmia Agents (therapeutic use)
• Child
• Electrocardiography
• Female
• Follow-Up Studies
• Heart Atria (physiopathology, surgery)
• Humans
• Male
• Middle Aged
• Monitoring, Intraoperative
• Tachycardia, Ectopic Atrial (drug therapy, physiopathology, surgery)
• Treatment Outcome