Catheter ablation of sinoatrial node reentrant tachycardia
Open accessAbstract
Objectives This study evaluates 1) the safety and efficacy of catheter delivery of radiofrequency current to eliminate sustained sinoatrial node reentrant tachycardia; 2) the incidence of sinoatrial node reentrant tachycardia in the current group of patients undergoing electrophysiologic study for paroxysmal supraventricular tachycardia; and 3) the association of sinoatrial node reentrant tachycardia with other tachyarrhythmias.Background Sustained sinoatrial node reentrant tachycardia is an uncommon cause of paroxysmal supraventricular tachycardia that is reported to occur infrequently in conjunction with other arrhythmias. Although pharmacologic and surgical therapies are available, there is limited information with regard to catheter ablation of sinoatrial node reentrant tachycardia.Methods Ten patients with sustained sinoatrial node reentrant tachycardia underwent electrophysiologic study and radiofrequency current ablation. Patients were followed up for 9.2 +/- 6.0 months.Results Of 343 consecutive patients referred for electrophysiologic evaluation of paroxysmal supraventricular tachycardia, 11 (3.2%) were found to have inducible sustained sinoatrial node reentrant tachycardia. Nine of the 11 patients had other associated arrhythmias, including atrioventricular (AV) node reentrant tachycardia (6 patients), AV reciprocating tachycardia (2 patients), ectopic atrial tachycardia (2 patients) and bundle branch reentrant tachycardia (1 patient). In 10 patients, direct ablation of sinoatrial node reentrant tachycardia was attempted and was successful in all (confidence interval for failure 0-0.26). Sinoatrial node reentrant tachycardia was eliminated with a median of four radiofrequency current applications (range 1 to 10) at 20 to 30 W. Successful ablation site characteristics during sinoatrial node reentrant tachycardia included 1) atrial activation > or = 35 ms (mean 44 +/- 8 ms) before the onset of the surface P wave, 2) atrial activation > or = 20 ms (mean 28 +/- 6 ms) before the onset of high right atrial activation, and 3) significantly prolonged and fractionated electrograms (mean duration 87 +/- 21 ms). No complications were encountered, and there have been no recurrences of sinoatrial node reentrant tachycardia.Conclusions Sinoatrial node reentrant tachycardia may be effectively and safely treated with radiofrequency current ablation at the site of earliest atrial activation.
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Sinus node reentrant tachycardia can be effectively and safely treated with catheter ablation targeting the earliest atrial activation relative to the P wave, with good long-term outcome.
“Sinus node reentrant tachycardia may be effectively and safely treated with catheter ablation targeting the site of earliest atrial activation with respect to the P wave.This treatment has been shown to be feasible with a good long-term outcome (Table 9).91”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [91]
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“6) Diagnosis of AT: A diagnosis of sino-atrial reentrant tachycardia (SART) was made based on the following criteria:7,8) (1) tachycardia reproducibly induced and terminated by atrial extrastimulation, (2) tachycardia induction by ventricular stimulation associated with a V-A-A-V activation sequence,9) (3) change of A…”
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“Catheter ablation of SANRT has been shown to be feasible with a good long-term outcome.(4,6-9) In 4 series of patients, 42 of 43 patients were treated successfully with ablation without recurrence.”
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Wharton, J. M. (1997) · Cardiac Electrophysiology Review · doi:10.1023/a:1009981104885
La ablación transcatéter: una técnica de la cardiología práctica diaria
Ruiz‐Granell, R., de Loma-Osorio, A. F., Martínez-Brotons, Á. M., Izquierdo, M., Sampio, P. P., Fuster, A. C., & Civera, R. G. (2010) · Revista Española de Cardiología Suplementos · doi:10.1016/s1131-3587(10)70110-2
Borloz, M. P., Mark, D. G., Pines, J. E. M., & Brady, W. J. (2010) · Emergencias
Sinoatrial Reentrant Tachycardia
Dick, M. (2006) · Developments in cardiovascular medicine · doi:10.1007/0-387-29170-9_7
Managing the patient with episodic sinus tachycardia and orthostatic intolerance
Narichania, A. D., Schleifer, J. W., & Shen, W.-K. (2014) · Cardiology Journal · doi:10.5603/cj.2014.0098
“Multiple studies have demonstrated the safety and efficacy of ablation [17, 29, 30].”
BackgroundAblación por radiofrecuencia mediante catéteres de las arritmias supraventriculares y ventriculares
Badhwar, N., Sanders, W. E., & Scheinman, M. M. (2006) · Elsevier eBooks · doi:10.1016/b978-84-458-1536-6.50025-7
Persistent Tachycardia Diagnosis and Management: Comments by J. Marcus Wharton, MD
Wharton, J. M. (1995) · CHEST Journal · doi:10.1016/s0012-3692(15)45176-1
R ADIO -F REQUENCY A BLATION AS T REATMENT FOR C ARDIAC A RRHYTHMIAS
Orady, F. R. M. (1999)
Katritsis, D. G., & Morady, F. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-79338-4.00021-2
Higa, S., Tai, C., & Chen, S. (2007) · doi:10.1002/9780470696279.ch8
Invasive EP Procedures for the Evaluation and Management of Atrial Tachycardia
Wharton, J. M. (2000) · Cardiac Electrophysiology Review · doi:10.1023/a:1009930901121
Catheter Ablation of Arrhythmias
Wylie, J. V., Wrobleski, D., & Josephson, M. E. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-5225-8.00085-4
Catheter Ablation of Arrhythmias
Ellis, E. R., Wylie, J. V., & Josephson, M. E. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24126-7.00086-7
Sakai, S., Maruyama, M., Oka, E., & Asai, K. (2025) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2025.07.015
The cardiac conduction system: A narrative review
Kariman, M., Pretterklieber, B., Pretterklieber, M. L., Hammer, N., Heijman, J., Plank, G., & Augustin, C. M. (2026) · Annals of Anatomy - Anatomischer Anzeiger · doi:10.1016/j.aanat.2026.152880
Atrial Tachycardia Originating from Crista Terminalis
Pappone, C., Oreto, G., Loricchio, M. L., Bianchi, S., & DICANDIA, C. D. (2000) · Springer eBooks · doi:10.1007/978-88-470-2139-6_29
- Authors
- Sanders, W. E., Sorrentino, R. A., Greenfield, R. A., Shenasa, H., Hamer, M. E., & Wharton, J. M.
- Affiliations
- Duke University (US)
- Corresponding author
- Wharton, J.Marcus
- ORCID
- Wharton, J.Marcus
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1994-03
- Volume
- 23
- Issue
- 4
- Pages
- 926-934
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1986919313
- Cited by
- 69
- References
- 31
- Citations by year
- 2026: 1 · 2025: 2 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 1 · 2016: 3 · 2015: 4 · 2014: 1 · 2013: 1
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p50hl017670-19, HL-17670)
- National Heart, Lung, and Blood Institute (HL17670)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- catheter ablation, radiofrequency ablation, paroxysmal supraventricular tachycardia, atrioventricular nodal reentrant tachycardia, atrioventricular reciprocating tachycardia, ectopic atrial tachycardia, electrophysiological study
- MeSH terms
- Adult, Electrocardiography, Female, Humans, Male, Middle Aged, Sinoatrial Node, Tachycardia, Sinoatrial Nodal Reentry, Tachycardia, Supraventricular, Incidence, Catheter Ablation
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