LONG-TERM OUTCOME OF OPERATIVE TREATMENT OF FOCAL ATRIAL TACHYCARDIA

BACKGROUND: This study examined the long-term clinical outcome of pati ents with focal atrial tachycardia who were treated surgically. Focal atrial tachycardia is a relatively rare arrhythmia that is often diffi cult to control with conventional medical therapy. Therapeutic modalit ies are not well defined because of the scarcity of long-term data of treated patients, including pathologic findings. STUDY DESIGN: Nine pa tients, six men and three women, ranging in age from 16 to 50 years (m ean of 34+/-14 years), underwent operative treatment for focal atrial tachycardia. The average rate of tachycardia was 167+/-22 beats per mi nute. All patients were treated with antiarrhythmic drugs (mean 2.9 dr ugs per patient). Concomitant operative procedures were performed upon four patients, including division of the accessory atrioventricular p athway for the Wolff-Parkinson-White syndrome in two patients, plicati on of the right atrium for idiopathic right atrial dilatation in one p atient, and a closure of the atrial septal defect in one patient. Foca l ablation was performed in all instances. RESULTS. There was no early or late death nor postoperative complications. Atrial tachycardia dis appeared and there were no episodes of recurrent tachycardia postopera tively during the mean follow-up period of 67+/-38 months. Histopathol ogic findings from four patients revealed a sinus node-like structure, diffuse chronic epimyocarditis, focal myocarditis, and fascicular dis array lesions. CONCLUSIONS: Excellent long-term result were obtained i n patients with focal atrial tachycardia who were treated operatively. Early operative intervention is preferable before the occurrence of i mpaired ventricular function. From the histopathologic findings, opera tive therapy should be selected in patients with diffuse atrial lesion s.