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Longstanding persistent accelerated idioatrial rhythm: Benign sinus node-like rhythm or insidious rhythm?
Hailei Liu1, Chao Zhu1, Bing Yang1
1Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Journal of Cardiovascular Electrophysiology
|May 10, 2017
Summary
Longstanding persistent accelerated idioatrial rhythm (AIAR) is an uncommon heart rhythm, often benign. While usually requiring no treatment, catheter ablation can resolve cases with rapid firing or tachycardia-mediated cardiomyopathy.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Longstanding persistent accelerated idioatrial rhythm (AIAR) lacks detailed description.
- This study investigates the clinical features, electrophysiology, diagnosis, treatment, and prognosis of AIAR.
Purpose of the Study:
- To describe the clinical manifestations and electrophysiological characteristics of longstanding persistent AIAR.
- To evaluate diagnostic methods, treatment options, and prognosis for AIAR.
Main Methods:
- Observational study of 15 patients with suspected AIAR.
- Utilized ECG, 24-hour Holter, isoproterenol testing, echocardiogram, and exercise treadmill tests.
- Electrophysiological study (EPS) and catheter ablation were performed as needed.
Main Results:
- AIAR showed a chronotropic profile similar to sinus rhythm (SR) and competed with SR when provoked.
- 10 patients were asymptomatic; 5 had concomitant atrial tachycardia.
- 8 out of 12 patients undergoing EPS had successful catheter ablation to eliminate AIAR.
Conclusions:
- Longstanding persistent AIAR is generally a benign atrial arrhythmia requiring no treatment.
- Rapid focal firing, associated atrial tachycardias, or tachycardia-mediated cardiomyopathy can worsen the clinical course.
- Catheter ablation is an effective treatment for complex AIAR cases.
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