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Published in: Journal of Interventional Cardiac Electrophysiology 1/2021

01-06-2021 | Antiarrhythmic Drugs

Outcomes of junctional ectopic tachycardia ablation in adult population—a multicenter experience

Authors: Tawseef Dar, Mohit K. Turagam, Bharath Yarlagadda, Valay Parikh, Jayasree Pillarisetti, Rakesh Gopinathannair, Carola Gianni, Sanghamitra Mohanty, Moussa Mansour, Luigi Di Biase, T. Jared Bunch, Andrea Natale, Dhanunjaya Lakkireddy

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2021

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Abstract

Purpose

Idiopathic junctional ectopic tachycardia (JET) is typically refractory to antiarrhythmic agents. Catheter ablation for JET is feasible but is associated with high risk of unintended atrioventricular (AV) block. There is limited data on the appropriate procedural technique and clinical outcomes with catheter ablation for idiopathic JET in adults.

Methods

This is a multicenter, retrospective study of all adult patients (age ≥ 18 years) who underwent catheter ablation for idiopathic JET. Patient, procedural characteristics, and long-term outcomes were evaluated.

Results

Fifteen patients [radiofrequency ablation (RF) = 14 and cryoablation = 1) were treated with catheter ablation. The median age was 58 years with 67% males. All patients underwent mapping of the right atrium and the aortic cusps prior to energy delivery. The location of earliest activation in relation to the atrioventricular (AV) node was postero-superior in 73% (11/15), posterior in 13% (2/15), and superior in 13% (2/15) respectively. Acute success was 100%. Arrhythmia recurrence occurred in 53% (8/15) all of whom underwent a repeat ablation. High-grade AV block requiring permanent pacemaker occurred in 20% (3/15). At 12-month follow-up in the redo-ablation group, 37.5% (3/8) had recurrence of the arrhythmia two of which underwent a third ablation procedure.

Conclusion

Catheter ablation of idiopathic JET in adults is associated with a high rate of recurrence requiring multiple procedures and high risk of AV block requiring a permanent pacemaker. Mapping and ablation of the non-coronary cusp can be considered as the arrhythmia was controlled in 3 patients with no inadvertent AV block.
Literature
1.
go back to reference Collins KK, Van Hare GF, Kertesz NJ, et al. Pediatric nonpost-operative junctional ectopic tachycardia medical management and interventional therapies. J Am Coll Cardiol. 2009;53:690–7.CrossRef Collins KK, Van Hare GF, Kertesz NJ, et al. Pediatric nonpost-operative junctional ectopic tachycardia medical management and interventional therapies. J Am Coll Cardiol. 2009;53:690–7.CrossRef
2.
go back to reference Garson A Jr, Gillette PC. Junctional ectopic tachycardia in children: electrocardiography, electrophysiology and pharmacologic response. Am J Cardiol. 1979;44:298–302.CrossRef Garson A Jr, Gillette PC. Junctional ectopic tachycardia in children: electrocardiography, electrophysiology and pharmacologic response. Am J Cardiol. 1979;44:298–302.CrossRef
3.
go back to reference Sarubbi B, Musto B, Ducceschi V, D’Onofrio A, Cavallaro C, Vecchione F, et al. Congenital junctional ectopic tachycardia in children and adolescents: a 20 year experience based study. Heart. 2002;88:188–90.CrossRef Sarubbi B, Musto B, Ducceschi V, D’Onofrio A, Cavallaro C, Vecchione F, et al. Congenital junctional ectopic tachycardia in children and adolescents: a 20 year experience based study. Heart. 2002;88:188–90.CrossRef
4.
go back to reference Saul JP, Scott WA, Brown S, Marantz P, Acevedo V, Etheridge SP, et al. Intravenous amiodarone for incessant tachyarrhythmias in children: a randomized, double-blind, antiarrhythmic drug trial. Circulation. 2005;112:3470–7.CrossRef Saul JP, Scott WA, Brown S, Marantz P, Acevedo V, Etheridge SP, et al. Intravenous amiodarone for incessant tachyarrhythmias in children: a randomized, double-blind, antiarrhythmic drug trial. Circulation. 2005;112:3470–7.CrossRef
5.
go back to reference Law IH, Von Bergen NH, Gingerich JC, Saarel EV, Fischbach PS, Dick M 2nd. Transcatheter cryothermal ablation of junctional ectopic tachycardia in the normal heart. Heart Rhythm. 2006;3:903–7.CrossRef Law IH, Von Bergen NH, Gingerich JC, Saarel EV, Fischbach PS, Dick M 2nd. Transcatheter cryothermal ablation of junctional ectopic tachycardia in the normal heart. Heart Rhythm. 2006;3:903–7.CrossRef
6.
go back to reference Rodriguez EV, Mejia LM. Radiofrequency catheter ablation of junctional ectopic tachycardia in adults. Int J Cardiol. 1999;70:75–81.CrossRef Rodriguez EV, Mejia LM. Radiofrequency catheter ablation of junctional ectopic tachycardia in adults. Int J Cardiol. 1999;70:75–81.CrossRef
7.
go back to reference Simmers TA, Sreeram N, Wittkampf FH, Derksen R. Radiofrequency catheter ablation of junctional ectopic tachycardia with preservation of atrioventricular conduction. Pacing Clin Electrophysiol. 2003;26:1284–8.CrossRef Simmers TA, Sreeram N, Wittkampf FH, Derksen R. Radiofrequency catheter ablation of junctional ectopic tachycardia with preservation of atrioventricular conduction. Pacing Clin Electrophysiol. 2003;26:1284–8.CrossRef
8.
go back to reference Pierick AR, Law IH, Muldonado JR, VON Bergen NH. Junctional ectopic tachycardia localization and procedural approach using cryoablation. Pacing Clin Electrophysiol. 2017;40:655–60.CrossRef Pierick AR, Law IH, Muldonado JR, VON Bergen NH. Junctional ectopic tachycardia localization and procedural approach using cryoablation. Pacing Clin Electrophysiol. 2017;40:655–60.CrossRef
9.
go back to reference Padanilam BJ, Manfredi JA, Steinberg LA, Olson JA, Fogel RI, Prystowsky EN. Differentiating junctional tachycardia and atrioventricular node re-entry tachycardia based on response to atrial extrastimulus pacing. J Am Coll Cardiol. 2008;52:1711–7.CrossRef Padanilam BJ, Manfredi JA, Steinberg LA, Olson JA, Fogel RI, Prystowsky EN. Differentiating junctional tachycardia and atrioventricular node re-entry tachycardia based on response to atrial extrastimulus pacing. J Am Coll Cardiol. 2008;52:1711–7.CrossRef
10.
go back to reference Srivathsan K, Gami AS, Barrett R, Monahan K, Packer DL, Asirvatham SJ. Differentiating atrioventricular nodal reentrant tachycardia from junctional tachycardia: novel application of the delta H-A interval. J Cardiovasc Electrophysiol. 2008;19:1–6.CrossRef Srivathsan K, Gami AS, Barrett R, Monahan K, Packer DL, Asirvatham SJ. Differentiating atrioventricular nodal reentrant tachycardia from junctional tachycardia: novel application of the delta H-A interval. J Cardiovasc Electrophysiol. 2008;19:1–6.CrossRef
11.
go back to reference Ruder MA, Davis JC, Eldar M, Abbott JA, Griffin JC, Seger JJ, et al. Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults. Circulation. 1986;73:930–7.CrossRef Ruder MA, Davis JC, Eldar M, Abbott JA, Griffin JC, Seger JJ, et al. Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults. Circulation. 1986;73:930–7.CrossRef
12.
go back to reference Liu CF, Ip JE, Lin AC, Lerman BB. Mechanistic heterogeneity of junctional ectopic tachycardia in adults. Pacing Clin Electrophysiol. 2013;36:e7–10.CrossRef Liu CF, Ip JE, Lin AC, Lerman BB. Mechanistic heterogeneity of junctional ectopic tachycardia in adults. Pacing Clin Electrophysiol. 2013;36:e7–10.CrossRef
13.
go back to reference Gillette PC, Garson A Jr, Porter CJ, et al. Junctional automatic ectopic tachycardia: new proposed treatment by transcatheter His bundle ablation. Am Heart J. 1983;106:619–23.CrossRef Gillette PC, Garson A Jr, Porter CJ, et al. Junctional automatic ectopic tachycardia: new proposed treatment by transcatheter His bundle ablation. Am Heart J. 1983;106:619–23.CrossRef
14.
go back to reference Tsoutsinos AJ, Papagiannis J, Chatzis AC, Sarris GE. Surgical cryoablation for life-threatening postoperative junctional tachycardia. Ann Thorac Surg. 2007;84:286–8.CrossRef Tsoutsinos AJ, Papagiannis J, Chatzis AC, Sarris GE. Surgical cryoablation for life-threatening postoperative junctional tachycardia. Ann Thorac Surg. 2007;84:286–8.CrossRef
15.
go back to reference Perry JC, Kearney DL, Friedman RA, Moak JP, Garson A Jr. Late ventricular arrhythmia and sudden death following direct-current catheter ablation of the atrioventricular junction. Am J Cardiol. 1992;70:765–8.CrossRef Perry JC, Kearney DL, Friedman RA, Moak JP, Garson A Jr. Late ventricular arrhythmia and sudden death following direct-current catheter ablation of the atrioventricular junction. Am J Cardiol. 1992;70:765–8.CrossRef
16.
go back to reference Wu MH, Lin JL, Chang YC. Catheter ablation of junctional ectopic tachycardia by guarded low dose radiofrequency energy application. Pacing Clin Electrophysiol. 1996;19:1655–8.CrossRef Wu MH, Lin JL, Chang YC. Catheter ablation of junctional ectopic tachycardia by guarded low dose radiofrequency energy application. Pacing Clin Electrophysiol. 1996;19:1655–8.CrossRef
17.
go back to reference Van Hare GF, Velvis H, Langberg JJ. Successful transcatheter ablation of congenital junctional ectopic tachycardia in a ten-month-old infant using radiofrequency energy. Pacing Clin Electrophysiol. 1990;13:730–5.CrossRef Van Hare GF, Velvis H, Langberg JJ. Successful transcatheter ablation of congenital junctional ectopic tachycardia in a ten-month-old infant using radiofrequency energy. Pacing Clin Electrophysiol. 1990;13:730–5.CrossRef
18.
go back to reference Ehlert FA, Goldberger JJ, Deal BJ, Benson DW, Kadish AH. Successful radiofrequency energy ablation of automatic junctional tachycardia preserving normal atrioventricular nodal conduction. Pacing Clin Electrophysiol. 1993;16:54–61.CrossRef Ehlert FA, Goldberger JJ, Deal BJ, Benson DW, Kadish AH. Successful radiofrequency energy ablation of automatic junctional tachycardia preserving normal atrioventricular nodal conduction. Pacing Clin Electrophysiol. 1993;16:54–61.CrossRef
19.
go back to reference Van Hare GF, Javitz H, Carmelli D, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol. 2004;15:759–70.CrossRef Van Hare GF, Javitz H, Carmelli D, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol. 2004;15:759–70.CrossRef
20.
go back to reference Hamdan M, Van Hare GF, Fisher W, et al. Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia. Am J Cardiol. 1996;78:1292–7.CrossRef Hamdan M, Van Hare GF, Fisher W, et al. Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia. Am J Cardiol. 1996;78:1292–7.CrossRef
21.
go back to reference Pap R, Makai A, Szilágyi J, et al. Should the aortic root be the preferred route for ablation of focal atrial tachycardia around the AV node? Support From Iintracardiac Echocardiography. JACC Clin Electrophysiol. 2016;2:193–9CrossRef Pap R, Makai A, Szilágyi J, et al. Should the aortic root be the preferred route for ablation of focal atrial tachycardia around the AV node? Support From Iintracardiac Echocardiography. JACC Clin Electrophysiol. 2016;2:193–9CrossRef
22.
go back to reference Tada H, Naito S, Miyazaki A, Oshima S, Nogami A, Taniguchi K. Successful catheter ablation of atrial tachycardia originating near the atrioventricular node from the noncoronary sinus of Valsalva. Pacing Clin Electrophysiol. 2004;27:1440–3.CrossRef Tada H, Naito S, Miyazaki A, Oshima S, Nogami A, Taniguchi K. Successful catheter ablation of atrial tachycardia originating near the atrioventricular node from the noncoronary sinus of Valsalva. Pacing Clin Electrophysiol. 2004;27:1440–3.CrossRef
Metadata
Title
Outcomes of junctional ectopic tachycardia ablation in adult population—a multicenter experience
Authors
Tawseef Dar
Mohit K. Turagam
Bharath Yarlagadda
Valay Parikh
Jayasree Pillarisetti
Rakesh Gopinathannair
Carola Gianni
Sanghamitra Mohanty
Moussa Mansour
Luigi Di Biase
T. Jared Bunch
Andrea Natale
Dhanunjaya Lakkireddy
Publication date
01-06-2021
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 1/2021
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-020-00749-3

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