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Dual loop reentrant tachycardia with a combination of a localized reentry and a macro-reentry.

ABSTRACT: A 78-year-old woman presented 2 years after mitral valve replacement for rheumatic mitral stenosis with cardioversion-resistant atrial tachycardia (AT). Dual-loop AT was identified by activation mapping with the Rhythmia™ system (Boston Scientific, Marlborough, MA, USA) and confirmed by entrainment-mapping; one circuit with localized re-entry turned around the scar on the posterior left atrium and the other circuit, which was macro re-entrant, turned around the left superior pulmonary vein (LSPV) using the PV-carina, the ridge beween the left atrial appendage and the LSPV, and the roof. The two wavefronts fused on the posterior wall close to the LSPV. Radiofrequency ablation of an area of slow conduction on the posterior wall changed the tachycardia to roof-dependent AT which was then terminated by completion of a roof line. <Learning objective: In this case report, we demonstrate the importance of using both conventional entrainment mapping methods and a novel ultra-high density mapping system to precisely understand the mechanism and appropriately terminate the complex atrial tachycardia in patients with prior atrial fibrillation ablation.>.

SUBMITTER: Takigawa M

PROVIDER: S-EPMC6149257 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Dual loop reentrant tachycardia with a combination of a localized reentry and a macro-reentry.

Takigawa Masateru M Frontera Antonio A Martin Ruairidh R Jais Pierre P Haïssaguerre Michel M Sacher Frederic F

Journal of cardiology cases 20170414 6

A 78-year-old woman presented 2 years after mitral valve replacement for rheumatic mitral stenosis with cardioversion-resistant atrial tachycardia (AT). Dual-loop AT was identified by activation mapping with the Rhythmia™ system (Boston Scientific, Marlborough, MA, USA) and confirmed by entrainment-mapping; one circuit with localized re-entry turned around the scar on the posterior left atrium and the other circuit, which was macro re-entrant, turned around the left superior pulmonary vein (LSPV ...[more]

PMID: 30279779

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Project description:Infarct border zone (IBZ) geometry likely affects inducibility and characteristics of postinfarction reentrant ventricular tachycardia, but the connection has not been established.The purpose of this study was to determine characteristics of postinfarction ventricular tachycardia in the IBZ.A geometric model describing the relationship between IBZ geometry and wavefront propagation in reentrant circuits was developed. Based on the formulation, slow conduction and block were expected to coincide with areas where IBZ thickness (T) is minimal and the local spatial gradient in thickness (DeltaT) is maximal, so that the degree of wavefront curvature rho proportional, variant DeltaT/T is maximal. Regions of fastest conduction velocity were predicted to coincide with areas of minimum DeltaT. In seven arrhythmogenic postinfarction canine heart experiments, tachycardia was induced by programmed stimulation, and activation maps were constructed from multichannel recordings. IBZ thickness was measured in excised hearts from histologic analysis or magnetic resonance imaging. Reentrant circuit properties were predicted from IBZ geometry and compared with ventricular activation maps after tachycardia induction.Mean IBZ thickness was 231 +/- 140 microm at the reentry isthmus and 1440 +/- 770 microm in the outer pathway (P <0.001). Mean curvature rho was 1.63 +/- 0.45 mm(-1) at functional block line locations, 0.71 +/- 0.18 mm(-1) at isthmus entrance-exit points, and 0.33 +/- 0.13 mm(-1) in the outer reentrant circuit pathway. The mean conduction velocity about the circuit during reentrant tachycardia was 0.32 +/- 0.04 mm/ms at entrance-exit points, 0.42 +/- 0.13 mm/ms for the entire outer pathway, and 0.64 +/- 0.16 mm/ms at outer pathway regions with minimum DeltaT. Model sensitivity and specificity to detect isthmus location was 75.0% and 97.2%.Reentrant circuit features as determined by activation mapping can be predicted on the basis of IBZ geometrical relationships.

Dataset Information

Dual loop reentrant tachycardia with a combination of a localized reentry and a macro-reentry.

Publications

Dual loop reentrant tachycardia with a combination of a localized reentry and a macro-reentry.

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