Intraatrial reentrant tachycardia originating from the prior suture line of the baffle in a patient who underwent the Mustard operation: Ultra-high-density.

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Date of download: 6/25/2016 Copyright © The American College of Cardiology. All rights reserved. From: Mechanism, localization and cure of atrial arrhythmias.

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Presentation transcript:

Intraatrial reentrant tachycardia originating from the prior suture line of the baffle in a patient who underwent the Mustard operation: Ultra-high-density 3-dimensional mapping Jae-Sun Uhm, MD, PhD, Hee Tae Yu, MD, PhD, Tae-Hoon Kim, MD, Boyoung Joung, MD, PhD, Hui-Nam Pak, MD, PhD, Moon-Hyoung Lee, MD, PhD HeartRhythm Case Reports Volume 4, Issue 10, Pages 451-454 (October 2018) DOI: 10.1016/j.hrcr.2018.06.012 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 Electrocardiogram obtained in the outpatient clinic. HeartRhythm Case Reports 2018 4, 451-454DOI: (10.1016/j.hrcr.2018.06.012) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 Intracardiac electrogram obtained during the tachycardia. Double potentials were recorded at spline B 4-5 of the Orion catheter. HeartRhythm Case Reports 2018 4, 451-454DOI: (10.1016/j.hrcr.2018.06.012) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 A: Ultra-high-density 3-dimensional activation map of the tachycardia showing figure-of-8 intraatrial reentrant tachycardia (white arrows) with the isthmus at the prior suture line at the inferior baffle. Figure in the white box is a magnified image of the reentry circuit. Two ablation lines were formed along the isthmus. The red filled-in circles indicate the ablation lesions. B: Fluoroscopic image of the ablation site. The SL-1 introducer was located in the pulmonary venous atrium through the baffle puncture. ∗ indicates radiofrequency catheter ablation site. CS = coronary sinus; IB = inferior baffle; IVC = inferior vena cava; LV = left ventricle; PVA = pulmonary venous atrium; SB = superior baffle; SVA = systemic venous atrium; SVC = superior vena cava. HeartRhythm Case Reports 2018 4, 451-454DOI: (10.1016/j.hrcr.2018.06.012) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Supplemental Figure 1 Cardiac computed tomography of the pulmonary (A) and systemic (B) venous atria. AA = atrial appendage, IVC = inferior vena cava, LIPV = left inferior pulmonary vein, LSPV = left superior pulmonary vein, MV = mitral valve, RIPV = right inferior pulmonary vein, RSPV = right superior pulmonary vein, SVC = superior vena cava, TV = tricuspid valve. HeartRhythm Case Reports 2018 4, 451-454DOI: (10.1016/j.hrcr.2018.06.012) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Supplemental Figure 2 Confirmation of bidirectional block of the cavotricuspid isthmus (CTI). A: CTI block during pacing at the coronary sinus. The signals from the low pulmonary venous atrium and distal high pulmonary venous atrium were delayed after CTI block. The double potentials become split (black arrows) at the distal ablation catheter appear after CTI block. B, C: The conduction time from the pacing site to the ostium of coronary sinus was longer at pacing at the low pulmonary venous atrium (B) than that at pacing at the mid pulmonary venous atrium (C). HiPVAd = distal high pulmonary venous atrium, HiPVAp = proximal high pulmonary venous atrium, LoPVAd = distal low pulmonary venous atrium, LoPVAp = proximal low pulmonary venous atrium, * = radiofrequency catheter ablation site. HeartRhythm Case Reports 2018 4, 451-454DOI: (10.1016/j.hrcr.2018.06.012) Copyright © 2018 Heart Rhythm Society Terms and Conditions