Herein we present a case of atrial tachycardia as a sequel of AF ablations. A 42-year-old man was admitted to our department because of a very symptomatic tachycardia. The patient, because of paroxysmal AF and typical...Herein we present a case of atrial tachycardia as a sequel of AF ablations. A 42-year-old man was admitted to our department because of a very symptomatic tachycardia. The patient, because of paroxysmal AF and typical atrial flutter, had been already submitted (three times) to ablation procedures in both left (pulmonary vein insulation) and right atria (cavo-tricuspidal isthmus). During the electrophysiological study, a huge and very fast atrial tachycardia was induced: 230 ms cycle length, 1/1 atrio-ventricular conduction with the ventricular rate of 260 bpm, complete left bundle branch block, and clinically recognized by the patient. Four minutes later, a 2/1 AV conduction without branch block permitted mapping and ablation. A high-density mapping around isthmus and coronary sinus (CS) was performed. The analysis of the chronological activation clearly showed a circuit propagation around the CS ostium with a very slow conduction in the anterior zone enlightened by the tight color progression, and counterclockwise activation of the right atrium lateral wall. In anterior zone of CS ostium diastolic fragmented electrograms were detected. After preventing his position localization, radiofrequency delivering (35 W) was effective to interrupt the arrhythmia in 3 seconds. Energy delivering was continued to anchor the lesion to the inferior vena cava. Confirmation of successful ablation was determined by unsuccessful attempts at reinduction of the arrhythmia, in basal state and during infusion of isoproterenol.展开更多
文摘Herein we present a case of atrial tachycardia as a sequel of AF ablations. A 42-year-old man was admitted to our department because of a very symptomatic tachycardia. The patient, because of paroxysmal AF and typical atrial flutter, had been already submitted (three times) to ablation procedures in both left (pulmonary vein insulation) and right atria (cavo-tricuspidal isthmus). During the electrophysiological study, a huge and very fast atrial tachycardia was induced: 230 ms cycle length, 1/1 atrio-ventricular conduction with the ventricular rate of 260 bpm, complete left bundle branch block, and clinically recognized by the patient. Four minutes later, a 2/1 AV conduction without branch block permitted mapping and ablation. A high-density mapping around isthmus and coronary sinus (CS) was performed. The analysis of the chronological activation clearly showed a circuit propagation around the CS ostium with a very slow conduction in the anterior zone enlightened by the tight color progression, and counterclockwise activation of the right atrium lateral wall. In anterior zone of CS ostium diastolic fragmented electrograms were detected. After preventing his position localization, radiofrequency delivering (35 W) was effective to interrupt the arrhythmia in 3 seconds. Energy delivering was continued to anchor the lesion to the inferior vena cava. Confirmation of successful ablation was determined by unsuccessful attempts at reinduction of the arrhythmia, in basal state and during infusion of isoproterenol.
