Atrial Tachycardia in a Patient With Fabry’s Disease

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Date of download: 7/6/2016 Copyright © The American College of Cardiology. All rights reserved. From: Catheter-induced linear lesions in theleft atrium.

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Presentation transcript:

Atrial Tachycardia in a Patient With Fabry’s Disease Radoslaw Marek Kiedrowicz, MD, PhD, Michael Cooklin, MD, Garry Carr-White, MD, Mark O’Neill, MD, PhD, FHRS HeartRhythm Case Reports Volume 2, Issue 2, Pages 124-127 (March 2016) DOI: 10.1016/j.hrcr.2015.10.007 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: Monomorphic atrial tachycardia at 270 ms stable cycle length. Isoelectric intervals between successive P waves and biphasic P-wave morphology (positive, then negative) in lead V1 suggesting focal right atrial arrhythmia origin. 25 mm/s paper sweep speed. B: Arrhythmia termination during radiofrequency application. I, II, V1: standard electrocardiogram leads; CS 1,2→9,10: distal-to-proximal pairs of electrodes of the decapolar coronary sinus catheter; Map p: the proximal pair of electrodes of the mapping catheter; Map d: the distal pair of electrodes of the mapping catheter. 50 mm/s paper sweep speed. C: Demonstration of mitral line conduction block by pacing lateral (*) and septal (**) to the ablation line with reversal of the CS activation sequence from distal–proximal to proximal–distal, respectively, and modification of the stimulus to right atrial P wave time. 50 mm/s paper sweep speed. HeartRhythm Case Reports 2016 2, 124-127DOI: (10.1016/j.hrcr.2015.10.007) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 CARTO 3 right and left atrial (LA) bipolar voltage maps in left anterior oblique projection. Normal (>0.5 mV, coded in pink) right atrial while low (<0.5 mV, coded in red) LA voltage zone throughout anterior wall and septum registered. Low-amplitude, long-duration systolic fractionated electrograms (FEGMs) observed within low LA voltage zone. A unique diastolic FEGM (pink dot) accounting for 33% of the tachycardia cycle length recorded halfway between anterior mitral annulus and right upper pulmonary vein, exclusively spanning electrocardiogram isoelectric interval. HeartRhythm Case Reports 2016 2, 124-127DOI: (10.1016/j.hrcr.2015.10.007) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 CARTO 3 left atrial activation map in left anterior oblique projection. Activation around mitral valve annulus (MA) covering 90% of the tachycardia cycle length consistent with clockwise perimitral flutter confirmed by entrainment from its anterior and posterior aspect (white panels). Ablation line between anterior MA and right upper pulmonary vein done (red dotted line) transecting the area of the diastolic fractionated electrogram registration (pink dot) where radiofrequency application terminated the tachycardia. HeartRhythm Case Reports 2016 2, 124-127DOI: (10.1016/j.hrcr.2015.10.007) Copyright © 2016 Heart Rhythm Society Terms and Conditions