Focal atrial tachycardia arising from the tricuspid annulus: Electrophysiologic and electrocardiographic characteristics

Joseph B. Morton, Prashanthan Sanders, D. A.S. Arvind, Jitendra K. Vohra, Paul B. Sparks, Jonathan M. Kalman

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Introduction: Focal right atrial tachycardia (RAT) arising from the crista terminalis, para-Hisian, and coronary sinus os regions are well described. Less information exists regarding RAT arising from the nonseptal region of the tricuspid annulus (TA). Methods and Results: From a consecutive series of 64 patients who had undergone successful radiofrequency ablation (RFA) of 67 RATs, the characteristics of 9 (13%) patients (6 men; mean age 50 ± 20 years) with a TA focus were reviewed. The annular focus was localized to the inferoanterior TA in 7 and the superior TA in 2. Mean tachycardia cycle length was 371 ± 66 msec. Mean activation time at the site of successful RFA in 9 of 9 patients was -43 ± 11 msec. At 9.3 ± 5.6 months of follow-up, 1 of 9 patients had recurrent tachycardia successfully treated with repeat RFA. In 7 of 9 patients with RAT from the inferoanterior TA, the surface ECG P wave morphology was upright in aVL, inverted in III and V1, and either inverted or biphasic with an initial negative deflection from V2 to V6. Conclusion: The TA is an important site of origin of RAT. In the present study, the inferoanterior region of the TA was a preferential site of origin with resulting characteristic P wave morphology. Knowledge of this anatomic distribution and P wave morphology allows targeted mapping and may facilitate successful RFA.

Original languageEnglish
Pages (from-to)653-659
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Issue number6
Publication statusPublished - 2001


  • Atrial tachycardia
  • Radiofrequency ablation
  • Tricuspid annulus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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