Long-term outcome of operative treatment of focal atrial tachycardia.
BACKGROUND
This study examined the long-term clinical outcome of patients with focal atrial tachycardia who were treated surgically. Focal atrial tachycardia is a relatively rare arrhythmia that is often difficult to control with conventional medical therapy. Therapeutic modalities are not well defined because of the scarcity of long-term data of treated patients, including pathologic findings.


METHODS
Nine patients, six men and three women, ranging in age from 16 to 50 years (mean of 34 +/- 14 years), underwent operative treatment for focal atrial tachycardia. The average rate of tachycardia was 167 +/- 22 beats per minute. All patients were treated with antiarrhythmic drugs (mean 2.9 drugs per patient). Concomitant operative procedures were performed upon four patients, including division of the accessory atrioventricular pathway for the Wolff-Parkinson-White syndrome in two patients, plication of the right atrium for idiopathic right atrial dilatation in one patient, and a closure of the atrial septal defect in one patient. Focal ablation was performed in all instances.


RESULTS
There was no early or late death nor postoperative complications. Atrial tachycardia disappeared and there were no episodes of recurrent tachycardia postoperatively during the mean follow-up period of 67 +/- 38 months. Histopathologic findings from four patients revealed a sinus node-like structure, diffuse chronic epimyocarditis, focal myocarditis, and fascicular disarray lesions.


CONCLUSIONS
Excellent long-term result were obtained in patients with focal atrial tachycardia who were treated operatively. Early operative intervention is preferable before the occurrence of impaired ventricular function. From the histopathologic findings, operative therapy should be selected in patients with diffuse atrial lesions.
Misaki
T
T
Department of Surgery, Toyama Medical and Pharmaceutical University, Japan.
Watanabe
G
G
Iwa
T
T
Ishida
K
K
Tsubota
M
M
Matsunaga
Y
Y
Watanabe
Y
Y
Fujiki
A
A
Inoue
H
H
Okada
R
R
D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation; D003452:Cryosurgery; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D013612:Tachycardia, Ectopic Atrial / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome