A case of an incision-related single-loop intra-atrial reentrant tachycardia showing an eccentric atrial activation sequence and widely separate potentials.

Slides:

Advertisements

Similar presentations

Date of download: 6/22/2016 Copyright © The American College of Cardiology. All rights reserved. From: Separating non-isthmus- from isthmus-dependent atrial.

Advertisements

Date of download: 6/26/2016 Copyright © The American College of Cardiology. All rights reserved. From: Mechanism and Location of Atrial Flutter in Transplanted.

Date of download: 7/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Recognition of far-field electrograms during entrainment.

Date of download: 9/19/2016 Copyright © The American College of Cardiology. All rights reserved. From: Noncontact three-dimensional mapping and ablation.

Date of download: 9/19/2016 Copyright © The American College of Cardiology. All rights reserved. From: Atrial Tachycardia After Circumferential Pulmonary.

Volume 4, Issue 1, Pages (January 2007)

Volume 2, Issue 1, Pages (January 2005)

Functional permanent 2:1 atrioventricular block treated with cardioneuroablation: Case report Tolga Aksu, MD, Sukriye Ebru Golcuk, MD, Tümer Erdem Guler,

Fei Lü, MD, PhD, FACC, FHRS, Taibo Chen, MD, Kenneth K

Peter Lukac, MD, PhD, Vibeke E. Hjortdal, MD, PhD, Anders K

Wolff-Parkinson-White syndrome due to a left atrial appendage–to–left ventricular connection: A case of a successful pathway elimination from inside of.

Incessant bundle branch reentrant ventricular tachycardia in a patient with corrected transposition of the great arteries Ken Kato, MD, Daigo Yagishita,

Successful ablation of premature ventricular contractions originating from the inferoseptal process of the left ventricle using a coronary sinus approach

John Green, MD, Zaid Aziz, MD, Hemal M. Nayak, MD, Gaurav A

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

Radiofrequency ablation of typical atrial flutter with access through the azygos vein in a patient with heterotopia utilizing high-density electroanatomic.

Volume 11, Issue 1, Pages (January 2014)

HeartRhythm Case Reports

A pseudo-sinus rhythm due to bigeminal ectopy with the focus in the right superior pulmonary vein Marina Arai, MD, Seiji Fukamizu, MD, PhD, Rintaro Hojo,

Takashi Nitta, MD, Masataka Mitsuno, MD, Chris K

Peri–coronary sinus atrial flutter associated with prior slow pathway ablation Mitsunori Maruyama, MD, PhD, FHRS, Shunsuke Uetake, MD, PhD, Yasushi Miyauchi,

A case of scar-related ventricular tachycardia demonstrating termination with nonglobal capture at the site of concealed entrainment with dual slow conduction.

Induction of tachycardia confined within a pulmonary vein by electrical cardioversion of atrial fibrillation: Is it proof of reentry? Mauro Toniolo,

Maged F. Nageh, MD,FHRS, Kamal Kotak, MD HeartRhythm Case Reports

Limitations of 12-lead electrocardiogram wide complex tachycardia algorithms in a patient with left atrial flutter and large myocardial infarction Carlos.

Functional permanent 2:1 atrioventricular block treated with cardioneuroablation: Case report Tolga Aksu, MD, Sukriye Ebru Golcuk, MD, Tümer Erdem Guler,

Claudio Hadid, MD, Sergio Gonzalez, MD, Jesús Almendral, MD, PhD

Preferential properties with decremental conduction of the Marshall vein between the coronary sinus and left superior pulmonary vein Toshiya Kurotobi,

Dual-loop biatrial concomitant macroreentrant tachycardia in a patient without previous history of surgery or ablation Song-Yun Chu, MD, Li-Bin Shi,

Perimitral atrial flutter associated with a protected coronary sinus after a Maze IV procedure and concomitant mitral annulus repair Gaku Kanda, MD,

Microreentrant left atrial tachycardia circuit mapped with an ultra-high-density mapping system Fu Siong Ng, MRCP, PhD, Fernando Guerrero, BSc, Vishal.

Pseudo typical atrial flutter occurring after cavotricuspid isthmus ablation in a patient with a prior history of Senning operation Naoki Yoshida, MD,

Isolation of the conduction between the Marshall bundle and distal coronary sinus and the entire coronary sinus for an atrial tachycardia after catheter.

Bradley D. Brochu, MD, Ahmed Abdi-Ali, MD, Jeffrey Shaw, MD, F

Wide complex tachycardia in an elderly woman due to Ebstein’s anomaly with two accessory pathways Vlad Radulescu, MD, Joseph Donnelly, MD, Jonathan Willner,

An unusual atrioventricular accessory pathway with an oblique course

Adenosine-sensitive atrial tachycardia originating from the anterior mitral annulus Dai Inagaki, MD, Rintaro Hojo, MD, Seiji Fukamizu, MD, PhD, Harumizu.

Cavotricuspid isthmus ablation using multimodality imaging in Ebstein anomaly with a mechanical tricuspid valve replacement Sang Hyun Lee, MD, Hyung.

Pseudo-conduction block at the mitral isthmus in a patient with epicardial impulse propagation through the vein of Marshall Rintaro Hojo, MD, Seiji Fukamizu,

Single-catheter validation of bidirectional block during atrial flutter ablation Piotr Futyma, MD, Marian Futyma, MD, PhD, Konrad Dudek, MD, Piotr Kułakowski,

Macroreentrant form of an adenosine 5′-triphosphate–sensitive atrial tachycardia arising from the vicinity of the atrioventricular node involving the.

Focal atrial fibrillation presenting in the origin of atrial tachycardia Chin-Yu Lin, MD, Yenn-Jiang Lin, MD, Fa-Po Chung, MD, Shih-Ann Chen, MD HeartRhythm.

Paroxysmal 1:1 narrow complex tachycardia: What is the mechanism?

A rare mechanism of tachycardia and aberrancy

Tina Baykaner, MD, MPH, Joshua M. Cooper, MD, FHRS

Electroanatomical high-density mapping of different tachycardias in the right atrium after heart transplantation Alexandra Schratter, MD, Valentina Schirripa,

Atrial Tachycardia in a Patient With Fabry’s Disease

Subvalvular catheter ablation of the cavotricuspid isthmus in a patient with Ebstein's anomaly and tricuspid valve replacement Roberto G. Gallotti, MD,

Bundle branch reentry: A novel mechanism for sustained ventricular tachycardia in Chagas heart disease Alvaro V. Sarabanda, MD, PhD, Wagner L. Gali,

Mapping of a postinfarction left ventricular aneurysm–dependent macroreentrant ventricular tachycardia Elad Anter, MD, Jianqing Li, MD, Cory M. Tschabrunn,

Biatrial flutter circuit involving an anomalous insertion of the Bachmann bundle into the superior vena cava Ely Gracia, MD, Roger Fan, MD, FHRS HeartRhythm.

Radiofrequency ablation of common atrial flutter via right subclavian/jugular vein access in a patient with bilateral lower limb venous obstruction: Importance.

Hiroko Asakai, MD, Laura Fenwick, BSc, Robert M. Hamilton, MD, FRCP(C)

Circular mapping recordings in a persistent left superior vena cava during atrial tachycardia: Was isolation achieved? Sandrine Venier, MD, Jason G.

Successful catheter ablation of idiopathic ventricular tachycardia originating from the top of the left ventricular posterior papillary muscle near the.

Utility of entrainment pacing to clarify the circuit of macroreentrant tachycardia with dual early sites on activation maps Koichi Nagashima, MD, PhD,

Abnormal atrial strain with speckle-tracking echocardiography predicts the arrhythmic substrate of atypical right atrial flutter Hiroshi Kawakami, MD,

Successful fluoroless ablation of an incessant atypical atrial flutter attributed to AtriClip usage during mini-MAZE surgery for persistent atrial fibrillation

Colin Yeo, MBBS, Martin S. Green, MD, Girish M

Clinical and electrophysiological features of respiratory cycle–dependent atrial tachycardia: An analysis of three cases Osamu Inaba, MD, Junichi Nitta,

Peter Kabunga, MBChB, MRCP, George J. Klein, MD, FHRS, Raymond W

Clinical problem solving: Maneuvering around a narrow complex tachycardia in a patient with Mustard repair for transposition of the great arteries Nicholas.

Analysis of variable conduction ratios into the atrioventricular node during atrial flutter: Multilevel block theory Kazushi Tanaka, MD, PhD, FACC, Osamu.

Usefulness of a 2-F catheter electrode in a case with successful electrical isolation of remarkably hypoplastic right inferior pulmonary vein Takeshi.

Two apparently remote types of ventricular tachycardia from a single right bundle branch focal source Jaromír Josiek, MD, Jaroslav Januška, MD, PhD,

Left atrial access via an unroofed coronary sinus to eliminate fast/slow atypical AVNRT: A case report Gustavo X. Morales, MD, Yousef H. Darrat, MD,

Jeffrey Munro, DO, Win-Kuang Shen, MD, FHRS, Komandoor Srivathsan, MD

Atrial fibrillation ablation with persistent left superior vena cava detected during intracardiac echocardiography Victor A. Abrich, MD, Jeffrey Munro,

A wide QRS complex tachycardia utilizing an atypical accessory pathway in latent Wolff- Parkinson-White syndrome: Manifestation of anterograde conduction.

Electrophysiological evidence of localized reentry as a trigger and driver of atrial fibrillation at the junction of the superior vena cava and right.

Presentation transcript:

A case of an incision-related single-loop intra-atrial reentrant tachycardia showing an eccentric atrial activation sequence and widely separate potentials resembling a double- loop reentry; its mechanism and analysis Kazushi Tanaka, MD, PhD, Shinji Shiotani, MD, Keisuke Fukuda, MD, Nobuyuki Morioka, MD, Yoshiaki Yokoi, MD, PhD, Osamu Fujimura, MD HeartRhythm Case Reports Volume 3, Issue 8, Pages 402-406 (August 2017) DOI: 10.1016/j.hrcr.2017.06.002 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Surface 12-lead electrocardiogram (ECG) (A) and intracardiac electrograms (B) of the tachycardia. A: There are no typical saw-tooth-like waves in inferior leads. B: ECG leads I, II, and V1 and intracardiac electrograms from the right atrium (RA; p, m, and d; proximal, middle, and distal), the His bundle area (HBE), around the tricuspid valve (Halo; 19-20 proximal and 1-2 distal), and the coronary sinus (CS; 7-8 proximal and 1-2 distal) are shown from top to bottom at a paper speed of 100 mm/s. The tachycardia has a cycle length of about 270 ms and an eccentric atrial activation sequence from the Halo 1-2 to 19-20 electrode pairs with widely separate potentials (SPs) on the Halo 7-8 to 9-10 electrograms. Note the cycle length alternans of the tachycardia, 270 ms and 280 ms. See text for details. Number on the Halo 9-10 indicates the interval between the first portion of the SPs (SP1) and the second portion (SP2). Arrows indicate the atrial activation sequences. Note that the atrial activation sequence changes near the Halo 15-16 electrode pair. A = atrial potential; V = ventricular potential. These abbreviations, the Halo and CS electrograms arrangement, and paper speed are the same as in the next figures. HeartRhythm Case Reports 2017 3, 402-406DOI: (10.1016/j.hrcr.2017.06.002) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Outcomes of entrainment pacing at multiple atrial sites of the Halo electrode (A and B), proximal coronary sinus (C), and successful ablation site (D) and termination (E). A and B show the entrainment pacing with a pacing cycle length of 250 ms at the Halo 1-2 and 15-16 electrode pairs, respectively. Solid and broken arrows indicate the atrial activation sequences corresponding to the last stimulus (St) and the first beat of the tachycardia immediately after the last St, respectively. Postpacing intervals (PPIs) represent the first tachycardia cycle length immediately after the last stimulus. A: After an impulse stimulated at the Halo 1-2 electrode pair reaches the Halo 15-16 with a conduction time of 160 ms in a caudocranial direction, it goes down toward the Halo 1-2 in an opposite direction. Thereafter, the tachycardia resumes. Thus, the PPI is identical to the tachycardia cycle length. Note that the interval between the SP1 and the SP2 is the same value as that during the tachycardia. A figure on a bidirectional arrow indicates an interval between the first atrial beats of the tachycardia on the Halo 1-2 and the CS 7-8 electrode immediately after the last St. B: A pacing impulse at the Halo 15-16 can reach the Halo 1-2 with a conduction time of 110 ms in a craniocaudal direction and go back toward the Halo 15-16 in an opposite direction, followed by the resumption of the tachycardia. Thus, the PPI is 290 ms. Note that the interval between the SP1 and SP2 on the Halo 9-10 during the entrainment pacing is 80 ms, shorter than that during pacing at the Halo 1-2. Also, the oscillation of atrial cycle lengths exists only at the CS 7-8 electrodes. This indicates that the pacing impulse traveled to the CS 7-8 through other route(s) different from the tachycardia circuit. C: Entrainment pacing from the CS 7-8, so that the PPI is 370 ms. Therefore, the CS 7-8 site could be considered to be far from the reentrant circuit. Additionally, the interval between the stimulus artefact and the Halo 1-2 required 130 ms, much longer than that during the tachycardia. See text for details. A figure below a bidirectional arrow illustrates the same interval as that shown in panel A. D: Successful ablation site. E: Termination of the tachycardia during the first energy delivery, respectively. Note that in panel D, the distal electrode pair of the ablation catheter (ABL) has the fragmented and multicomponent atrial potentials (A*) similar to that on the Halo 1-2, and in panel E, the tachycardia terminates after the atrial potentials on the ABL are rendered single. HeartRhythm Case Reports 2017 3, 402-406DOI: (10.1016/j.hrcr.2017.06.002) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Positions of electrode catheters, incision, and ablations on the 3-dimensional right atrial map (A) and the schema of the incisional single-loop intra-atrial reentrant tachycardia (B). A: The positional relationship of electrode catheters (Halo, RA, CS, and HBE), the incisional line (blue dots), and ablations (red dots), including the first site (white dot) on the 3-dimensional RA electroanatomic map in right anterior oblique (RAO) view. SVC = superior vena cava; IVC = inferior vena cava; Halo = duodecapolar electrode; RA = right atrium; CS = coronary sinus; HBE = His bundle electrode. B: Schema of the RA in RAO view with an activation sequence of the tachycardia indicated by blank arrows, rotating around the incisional line (the interrupted line) in a counterclockwise direction. The continuous line denotes the HALO catheter. Numbers indicate the electrode pairs on the HALO catheter in panel B as well as panel A. CSos = ostium of coronary sinus; SP1 and 2 = the first and second portion of separate atrial potentials on the Halo 9-10 electrode pair, respectively; TA = tricuspid annulus; CTI = cavotricuspid isthmus. See text for details. HeartRhythm Case Reports 2017 3, 402-406DOI: (10.1016/j.hrcr.2017.06.002) Copyright © 2017 Heart Rhythm Society Terms and Conditions