Atrial Tachycardia Arising From the Crista Terminalis, Detailed Electrophysiological Features and Long-Term Ablation Outcomes

Gwilym M. Morris, Louise Segan, Geoff Wong, Gareth Wynn, Troy Watts, Patrick Heck, Tomos E. Walters, Ashley Nisbet, Paul Sparks, Joseph B. Morton, Peter M. Kistler, Jonathan M. Kalman

Research output: Contribution to journalArticlepeer-review

205 Downloads (Pure)


Objectives: The goal of this study was to characterize, in detail, focal atrial tachycardia (AT) arising from the crista terminalis to investigate associations with other atrial arrhythmia and to define long-term ablation outcomes. Background: The crista terminalis is known to be the most common site of origin for focal AT, but it is not well characterized. Methods: This study retrospectively identified a total of 548 ablation procedures for AT performed at a single center over a 16-year period, of which 171 were arising from the crista terminalis. Results: Compared with patients with other AT sites of origin, crista terminalis AT patients were older (57.3 vs. 47.3 years), more commonly female (72.9% vs. 59.1%), were more commonly associated with coexistent atrioventricular nodal re-entry tachycardia (17.1% vs. 9.7%), and were more likely to be inducible with programmed stimulation (81.5% vs. 58.9%). There was preferential conduction in the superior-inferior axis along the crista terminalis. Acute ablation success rate was high (92.2%) and improved significantly when three-dimensional mapping was used (98.5%). Recurrence in the first 12 months after a successful ablation was 9.7%. Only 2 patients developed atrial fibrillation over the long-term follow-up of >7 years. Conclusions: This large series characterized the clinical and electrophysiological features and immediate and long-term ablation outcomes for AT originating from the crista terminalis. Features of the tachycardia suggest that age-related localized remodeling of the crista terminalis causes a superficial endocardial zone of conduction slowing leading to re-entry. Ablation outcomes were good, with long-term freedom from atrial arrhythmia.

Original languageEnglish
Pages (from-to)448-458
Number of pages11
JournalJACC: Clinical Electrophysiology
Issue number4
Early online date27 Mar 2019
Publication statusPublished - 1 Apr 2019


  • ablation
  • atrial tachycardia
  • crista terminalis


Dive into the research topics of 'Atrial Tachycardia Arising From the Crista Terminalis, Detailed Electrophysiological Features and Long-Term Ablation Outcomes'. Together they form a unique fingerprint.

Cite this