A case of successful termination of an atrial tachycardia ablated from the pulmonary artery during rapid ventricular pacing Toshiya Kurotobi, MD, PhD,

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Presentation transcript:

A case of successful termination of an atrial tachycardia ablated from the pulmonary artery during rapid ventricular pacing Toshiya Kurotobi, MD, PhD, Naoto Kino, MD, Kazato Ito, MD, Daisuke Tonomura, MD, Kentaro Yano, MD, Yoshihisa Shimada, MD, PhD HeartRhythm Case Reports Volume 1, Issue 3, Pages 133-136 (May 2015) DOI: 10.1016/j.hrcr.2015.01.004 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 a: Surface ECG recorded during atrial tachycardia (AT). P-wave polarity during the AT was positive in leads II, III, aVF, and V1 and negative in leads I and aVL. The AT cycle length was 510 ms. b: Findings from ablation in the pulmonary artery. The earliest local atrial potential preceded P-wave onset by 52 ms. Ablation from that site temporarily accelerated the AT rate (116 to 159 bpm); however, the AT could not be successfully terminated. c: Catheter location at the earliest activation site of AT. The ablation catheter was located on the anterior side of the left atrial roof. ABL = ablation catheter; CS = coronary sinus; LAA = left atrial appendage; LAO = left anterior oblique; RA = right atrium; RAO = right anterior oblique. HeartRhythm Case Reports 2015 1, 133-136DOI: (10.1016/j.hrcr.2015.01.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 a: The sinus nodal artery (SNA) from the left circumflex artery along the left atrial roof is clearly visible (arrowheads) in fluoroscopic views. b: Multidetector computed tomographic image. Horizontal axis shows the left SNA (arrow) running along the left atrial (LA) roof between the left atrial appendage (LAA) and left superior pulmonary vein (LSPV). Longitudinal axis shows the Bachmann bundle (BB) coexisting with the SNA (arrow) and located between the LA roof and the pulmonary artery (PA). AO = aorta; LV = left ventricle. HeartRhythm Case Reports 2015 1, 133-136DOI: (10.1016/j.hrcr.2015.01.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 a: Pressure monitoring during rapid ventricular pacing. Systemic systolic pressure decreased suddenly from 110 to 70 mm Hg during the pacing maneuver. b: Radiofrequency energy application up to 50W successfully terminated the atrial tachycardia (AT) after 20 seconds from the start of the application. During ventricular pacing, activation of the atrium and ventricle became dissociated. However, we could easily identify the change in atrial activation sequence, with remarkable prolongation of the AT cycle length (437 to 617 ms, long arrow). HeartRhythm Case Reports 2015 1, 133-136DOI: (10.1016/j.hrcr.2015.01.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions