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

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Presentation on theme: "Adenosine-sensitive atrial tachycardia originating from the anterior mitral annulus  Dai Inagaki, MD, Rintaro Hojo, MD, Seiji Fukamizu, MD, PhD, Harumizu."— Presentation transcript:

1 Adenosine-sensitive atrial tachycardia originating from the anterior mitral annulus 
Dai Inagaki, MD, Rintaro Hojo, MD, Seiji Fukamizu, MD, PhD, Harumizu Sakurada, MD, PhD, Masayasu Hiraoka, MD, PhD, FHRS  HeartRhythm Case Reports  Volume 4, Issue 11, Pages (November 2018) DOI: /j.hrcr Copyright © 2018 Heart Rhythm Society Terms and Conditions

2 Figure 1 Twelve-lead electrocardiography revealed an episode of long RP, narrow QRS regular tachycardia with a heart rate of 170 bpm. The P-wave morphologies during the tachycardia were positive in leads II, III, aVF, and V1. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Catheter position when entrainment pacing was performed from the site at 1 o’clock on the mitral annulus (MA). Activation mapping revealed earliest atrial activation at 10 o’clock on the MA and a centrifugal pattern from that site. The catheter electrodes encircled by red circles were captured orthodromically and those encircled by blue circles were captured antidromically. B: Intracardiac electrograms. Red and blue asterisks indicate the last electrograms captured using the last pacing stimulus. Catheter electrodes indicated with red asterisks were captured orthodromically and those indicated with blue asterisks were captured antidromically. ABL = ablation; CS = coronary sinus; HBE = His-bundle electrogram; HRA = high right atrium; LAO = left anterior oblique; LAT = local activation time; RVA = right ventricular apex. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

4 Figure 3 Supposed conduction pathway and capture style of each electrode (orthodromically or antidromically) when entrainment pacing was performed from the site at 1 o’clock on the mitral annulus (MA). A critical slow conduction zone existed between the exit and 1 o’clock on the MA (pacing site). After radiofrequency energy was delivered to exit 1, it was suspected that the atrial tachycardia (AT) had changed its exit to another one (exit 2). AT was terminated within 1.2 seconds after ablation was started at exit 2. It was believed that ablation at the site that successfully terminated the AT modified not only the exit but also the critical slow conduction zone near the ablation site, and this contributed to AT termination. CS = coronary sinus; HBE = His-bundle electrogram; HRA = high right atrium; LAT = local activation time. HeartRhythm Case Reports 2018 4, DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

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