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Catheter Ablation of Atrial Tachycardia is Prefered for Symptomatic Patient with
Optimal Medical Treatment
Fauziar Ahnaf, Krisna Jayantika, Wella Karolina, Budi Patria, Andy Kristyagita, Sunu B Raharjo
Department of Cardiology and Vascular Medicine, Indonesia University Faculty of Medicine
National Cardiovascular Center Harapan Kita
Department of Cardiology and Vascular Medicine, Diponegoro University Faculty of Medicine
Dr. Kariadi Hospital, Semarang, Indonesia
Background: Atrial tachycardia (AT) is an uncommon arrhythmia. AT accounts for 5 to 15%
of adults undergoing electrophysiological studies. Automatic AT tends to be a condition that
affects the young, whereas AT due to microreentry is more common in older populations. The
lack of efficacy of antiarrhythmic therapy and the advent of radiofrequency ablation have
altered our primary approach to the treatment of focal atrial tachycardia.
Case Presentation: A 74-year-old woman was admitted to our center with recurrent of
palpitation and dizziness for 2 years. The patient had been diagnosed with hypertension and
diabetes mellitus, stable coronary disease at that time. She had undergone a Coronary Artery
Bypass Graft Operation 6 months prior. The clinical tachycardia presented with abrupt onset
and offset. The 12-lead electrocardiogram (ECG) at the time of admission demonstrated regular
sinus rhythm with Atrial Premature Complex with Coronary Sinus origin morphology. The P
wave polarity of APC was biphasic (initially positive and a late negative component) in lead
V1, positive in the lead AVL, and negative in lead II, III, AVF. A Holter ECG Monitoring,
recorded during an episode of palpitations revealed a Frequent Burst of APC. Echocardiography
revealed no evidence of structural heart disease with a normal left ventricular function.
Optimalized medical therapy with Bisoprolol and Verapamil was done. Then, She got syncope
due to Sinus Arrest with Junctional Escape Rhythm. Radiofrequency ablation was performed
Succesfully in the Coronary Sinus area. An evaluation of Symptoms and Holter ECG
monitoring showed improvement
Conclusion: Optimalized anti arrhythmia drugs can suppress not only the arrhythmia but also
the native pacemaker. Catheter ablation of Atrial Tachycardia is reserved for symptomatic cases
refractory to medical therapy
Keywords: Atrial Tachycardia, Ablation