OBJECTIVES: Accurate diagnosis of the mechanism and origin site of paroxysmal supraventricular tachycardia(PSVT) can be made using electrophysiologic study(EPS). Recently, radiofrequency catheter ablation technique has been introduced and widely used for the definitive treatment of various forms of PSVT, thereby precise determination of the mechanism of PSVT can be possible. It has been known that atrioventricular reentry tachycardia (AVRT) using concealed bypass tract is more frequent than atrioventricular nodal reentry tachycardia (AVNRT) in Korea. But it is not certain that those studies represent actual distribution of PSVT in Korea. This study was designed to determine the mechanism and clinical characteristics of PSVT in Korea. METHODS: We investigated 136patients in whom electrophysiolosic study was performed from October 1992 through October 1994 at the Chonnam National University Hospital, the only tertiary referral center of the Kwangju-Chonnam area of Korea. RESULTS: 1) The electrophysiologic mechanism of PSVT was AVNRT in 44patients(32.4%), WPW syndrome in 46(33.8%), AVRT using concealed bypass tract in 40(29.4%), sinoatrial nodal reentry tachycardia (SANRT) in 4(2.9%), and automatic atrial tachycardia(AAT) in 2(1.5%), ensuing that AVNRT is most common mechanism of PSVT with no preexcitation during sinus rhythm. 2) Male is more frequent than female in AVNRT, WPW syndrome, and AVRT, which was most prominent in WPW syndrome. 3) The first episode of symptom occured at the age of 34.9 +/- 17.3 years in AVNRT, 25.5 +/- 13.3 years in WPW and 26.3 +/- 15.0 years in AVRT(p<0.05). There was no significant difference in the duration of symptom. The tachycardia rate in WPW syndrome was 183.6 +/- 23.9 per minute and AVRT was 186.7 +/- 38.0 per minute, which were faster than that of AVNRT(161.7 +/- 28.6/min)(p<0.05). 4) There was no significant difference in the presenting symptoms and in the provocation factors between AVNRT and AVRT. CONCLUSION: AVNIlT is most common mechanism of PSVT with no preexcitation during sinus rhythm, developed at older age than WPW syndorme and AVRT, and had lower tachycardia rate than WPW syndrome and AVRT.
Catheter Ablation ; Diagnosis ; Female ; Humans ; Jeollanam-do ; Korea ; Male ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Sinoatrial Nodal Reentry ; Tachycardia, Supraventricular* ; Tertiary Care Centers ; Wolff-Parkinson-White Syndrome

Radiofrequency catheter ablation (RFCA) has been established as an effective and safe treatment modality for atrioventricular nodal reentrant tachycardia and WPW syndrome. Surgical ablation or direct current catheter ablation had been performed to cure focal atrial tachycardia (AT), however, these treatments had limitations such as the need of open thoracotomy or the risk of barotrauma. RFCA could be an effective treatment modality for cure of AT. We performed RFCA for AT in 22 patients (male 13, mean age 38.1+/-15.4 years) among 831 patients who underwent electrophysiologic study between Jul. 1996 and May. 1999. Clinical pattern of tachycardia was paroxysmal (17 patients) or incessant (mean duration of symptoms, 41.1+/-42.3 months). Associated cardiac diseases were tachycardia-mediated cardiomyopathy (3 patients), aortic stenosis (1 patient) and ventricular septal defect with pulmonic stenosis (1 patient). AT was induced by programmed electrical stimulation in 17 patients: AT in the other 5 patients was incessant. The RFCA was successful in 17 patients (77.3%). The mean interval between atrial electrogram of mapping catheter and P wave of surface ECG was -53.5+/-24.9msec in 17 successful sites. Fractionated atrial activities were invariably found in the successful sites. Successful sites of RFCA for right AT were around coronary sinus ostium (5), crista terminalis (4), lower portion of sinus node (1), inferior portion of tricuspid annulus (1), and His area (1), respectively. In left AT, lateral portion near atrioventricular groove (2), inferoposterior portion (2) and near left atrial appendage (1) were successful site. During follow-up (mean 23 months), one patient had recurrence (recurrence rate 5.9%). RFCA for AT is an effective and curative treatment in selected cases.
Aortic Valve Stenosis ; Atrial Appendage ; Barotrauma ; Cardiomyopathies ; Catheter Ablation* ; Catheters ; Coronary Sinus ; Electric Stimulation ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Follow-Up Studies ; Heart Diseases ; Heart Septal Defects, Ventricular ; Humans ; Pulmonary Valve Stenosis ; Recurrence ; Sinoatrial Node ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Thoracotomy ; Wolff-Parkinson-White Syndrome