title: Atrial macroreentry tachycardia in patients without obvious structural heart disease or previous cardiac surgical or catheter intervention: characterization of arrhythmogenic substrates, reentry circuits, and results of catheter ablation.
abstract: BACKGROUND
  Atrial macroreentry tachycardia (AMRT) in patients without obvious structural heart disease or previous surgical or catheter intervention has not been characterized in detail.
  
  
  RESULTS
  Electroanatomical mapping and ablation of right or left AMRT were performed in 33 patients. Right atrial central conduction obstacle was formed by an electrically silent area (ESA) in 15 (68%) patients and by a line of double potentials (DPs) in seven (32%) patients. Left atrial ESAs were found in all 11 patients with the left AMRT. Reentry circuit was reconstructed in 19 (86%) patients with right AMRT and seven (64%) patients with left AMRT. Of the ESA-related right AMRT, eight (50%) were double-loop reentry circuits utilizing a narrow critical isthmus within the ESA and eight (50%) were single-loop reentry circuits with a critical isthmus bounded by ESA and either ostium of the vena cava. Single-loop DP-related AMRTs had the critical isthmus between the DP line and the ostium of the inferior vena cava (IVC). Left AMRTs included a variety of single-, double-, or triple-loop reentry circuits and their critical isthmuses. During the 37 +/- 15 month follow-up, atrial tachyarrhythmia-free clinical outcome was achieved in 21 (95%) patients (18 patients, 82%, without antiarrhythmic drugs) with the right AMRT and in nine (82%) patients (six patients, 55%, without antiarrhythmic drugs) with the left AMRT.
  
  
  CONCLUSIONS
  The majority of right and left AMRTs were related to the presence of ESA. Ablation can be successful with a favorable risk of atrial tachyarrhythmia recurrence.
authors.affiliation: Department of Cardiology, Heart Center, Hospital Podlesí a.s., Trinec, Czech Republic. martin.fiala@nempodlesi.cz
authors.forename: Martin
authors.initials: M
authors.lastname: Fiala
authors.forename: Jan
authors.initials: J
authors.lastname: Chovancík
authors.forename: Radek
authors.initials: R
authors.lastname: Neuwirth
authors.forename: Renáta
authors.initials: R
authors.lastname: Nevralová
authors.forename: Otakar
authors.initials: O
authors.lastname: Jiravský
authors.forename: Libor
authors.initials: L
authors.lastname: Sknouril
authors.forename: Miloslav
authors.initials: M
authors.lastname: Dorda
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Januska
authors.forename: Alexandra
authors.initials: A
authors.lastname: Vodzinská
authors.forename: Jindrich
authors.initials: J
authors.lastname: Cerný
authors.forename: Igor
authors.initials: I
authors.lastname: Nykl
authors.forename: Marian
authors.initials: M
authors.lastname: Branny
mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping; D006328:Cardiac Catheterization; D017115:Catheter Ablation; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013612:Tachycardia, Ectopic Atrial / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology