Outcomes of junctional ectopic tachycardia ablation in adult population—a multicenter experience |
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Authors: | Dar Tawseef Turagam Mohit K Yarlagadda Bharath Parikh Valay Pillarisetti Jayasree Gopinathannair Rakesh Gianni Carola Mohanty Sanghamitra Mansour Moussa Di Biase Luigi Bunch T Jared Natale Andrea Lakkireddy Dhanunjaya |
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Institution: | 1.The Kansas City Heart Rhythm Institute (KCHRI), HCA MidWest, Overland Park, KS, 66221, USA ;2.Mount Sinai Hospital – Icahn School of Medicine, New York, NY, USA ;3.Division of Cardiovascular Medicine, University of Texas, San Antonio, TX, USA ;4.Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, USA ;5.Texas Cardiac Arrhythmia Institute, Austin, TX, USA ;6.Massachusetts General Hospital, Boston, MA, USA ;7.Department of Medicine (Cardiology), Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY, USA ;8.Intermountain Medical Center, Salt Lake City, UT, USA ; |
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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. MethodsThis 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. ResultsFifteen 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. ConclusionCatheter 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. |
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