Intraatrial reentrant tachycardia
- Munther K Homoud, MD
Munther K Homoud, MD
- Associate Professor of Medicine
- Tufts University School of Medicine
Atrial tachycardias have traditionally been characterized as automatic, triggered, or reentrant. However, the European Society of Cardiology and the North American Society of Pacing and Electrophysiology in 2001 proposed a classification that takes into consideration both anatomic features and electrophysiologic mechanisms . Atrial tachycardia is the overriding term that includes two major categories:
●Focal atrial tachycardia due to an automatic, triggered, or microreentrant mechanism
●Macroreentrant atrial tachycardia, including typical atrial flutter and other well-characterized macroreentrant circuits in the right and left atrium
Intraatrial reentrant tachycardia (IART) falls into the latter group. Furthermore, the joint American College of Cardiology/American Heart Association/Heart Rhythm Society 2015 guidelines further defined macroreentrant atrial tachycardias that do not involve the tricuspid valve isthmus as "atypical or non-cavo-tricuspid isthmus-dependent atrial flutter" . These macroreentrant supraventricular tachycardias often involve the left atrium, particularly after atrial fibrillation (AF) ablation or Maze surgery for AF. They may involve any atrium where a scar, surgical or catheter-induced, may have taken place. This topic will discuss the mechanisms, clinical manifestations, and treatment of IART. Discussions of other specific atrial arrhythmias are presented separately. (See "Focal atrial tachycardia" and "Sinoatrial nodal reentrant tachycardia (SANRT)" and "Overview of atrial flutter".)
DEFINITION, PREVALENCE, AND MECHANISMS
Intraatrial reentrant tachycardia (IART) refers to any macroreentrant atrial tachycardia that does not utilize the cavotricuspid isthmus (figure 1) as a critical pathway for the reentry to perpetuate. IART generally occurs in one of three settings: post-surgical repair of congenital heart disease (incidence of 16 to 50 percent post Fontan procedure, 15 to 48 percent post Mustard or Senning procedures, 12 to 34 percent post Tetralogy of Fallot repair), post-surgical scar (incisional tachycardia), or post catheter based or surgical management of atrial fibrillation (AF) [3,4]. With the increase in AF ablation, an increase in IART is arising due to the surgical maze and catheter based procedures in the left atrium. IART has also been reported in the absence of surgical or catheter intervention .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- DEFINITION, PREVALENCE, AND MECHANISMS
- CLINICAL MANIFESTATIONS
- Electrocardiographic findings
- Electrophysiological features
- Differential diagnosis
- Acute termination
- - Autonomic maneuvers
- - IV adenosine and verapamil
- Chronic therapy
- - Catheter ablation
- - Pharmacologic therapy
- - Permanent pacemaker insertion
- Our approach to treatment
- SUMMARY AND RECOMMENDATIONS