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Catheter Ablation of Atrial Tachycardia in a Giant Right Atrium.

ABSTRACT: A 25-year-old male patient with a giant right atrium presented with atrial tachycardia. Electroanatomic mapping revealed micro-re-entry from a low-voltage zone in the region of the right atrial appendage. Linear ablations across the low-voltage zone terminated the tachycardia. The remaining right atrial tissue was electrically normal. (Level of Difficulty: Intermediate.).

SUBMITTER: Kueffer T

PROVIDER: S-EPMC8298314 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Case Report: Application of Thoracoscopic Clamp Radiofrequency Ablation on Atrial Tachycardia Originating From Right Atrial Appendage After Catheter Ablation Failure.

Project description:Atrial tachycardia originating from the right atrial appendage has a higher probability of failure of catheter ablation. Here we report a case of a 13-year-old boy with incessant tachycardia, complicated by heart enlargement, and heart failure. Electrophysiological examination showed that atrial tachycardia (AT) originated from the apex of the right atrial appendage, and endocardial catheter ablation was ineffective. After thoracoscopic approach, the right atrial appendage was successfully ablated with bipolar radiofrequency ablation forceps, atrial tachycardia was terminated and sinus rhythm was restored. Within 3 months since the patient was discharged from the hospital, no arrhythmia occurred and the heart structure returned to normal. Thus, thoracoscopic clamp radiofrequency ablation may be a reasonable choice for young patients with atrial tachycardia originated from the right atrial appendage when transendocardial ablation is not effective.

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Contrast injection into the right atrial appendage apex using an external irrigation catheter for focal atrial tachycardia ablation.

Project description:Focal atrial tachycardias (ATs) originating from the right atrial appendage (RAA) apex are refractory to catheter ablation and can cause tachycardia-induced cardiomyopathy. After unsuccessful catheter ablation of these ATs, their elimination sometimes requires atrial appendectomy for treatment of tachycardia-induced cardiomyopathy. This case demonstrates that contrast injection into the RAA apex using an external irrigation catheter can facilitate mapping of such ATs and may provide safe and effective ablation of their sources even in the RAA tip.

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Atrial tachycardia related to atrial infarction treated with catheter ablation: a case report.

Project description:BackgroundAtrial infarction, usually concurrent with ventricular infarction, is under-recognized. Although most patients with atrial infarction have complicated supraventricular tachyarrhythmias, its mechanism is still unknown. We report a case of atrial tachycardia (AT) related to atrial infarction treated with catheter ablation.Case summaryA 51-year-old man was referred for acute chest pain. Electrocardiography showed a junctional rhythm with ST depression in the precordial leads. Emergency coronary angiography revealed an occluded dominant left circumflex coronary artery (LCX). A drug-eluting stent was deployed; however, the atrial branch from the distal side of the LCX was jailed by the stent and became occluded. On the 7th day, the premature atrial contractions (PACs) became frequent and changed to AT. Owing to its resistance to medication, we performed catheter ablation. The electro-anatomical map revealed counter-clockwise macro-reentrant tachycardia at the tricuspid valve annulus, with low-voltage and fragmented potential (FP) areas at the posterior wall of the right atrium (RA). After terminating the AT through linear ablation for the cavotricuspid isthmus, multiple-focus PACs originating from the FP area in the RA posterior wall were documented. Coronary angiography revealed that these damaged areas were perfused by the atrial branch of the LCX. Defragmentation in the FP area could eliminate PACs. The patient was discharged with sinus rhythm and without any complications.DiscussionWe can perform electro-anatomical mapping to identify tachycardia circuit and PACs arising from the FP area in the posterior RA, where the atrial branch was perfusing. Multiple PACs from infarcted myocardium result in tachycardia.

| S-EPMC9425842 | biostudies-literature

Entrapment of focal atrial tachycardia using cryoballoon ablation; Sinus rhythm in the left atrium and ongoing atrial tachycardia in the left atrial appendage.

Project description:Left atrial appendage (LAA) is a well-known source of focal atrial tachycardias (AT). Although radio-frequency (RF) energy is the most commonly used technique in such cases, there was an option other than epicardial approach when RF technique fails. Cryoballoon technology is primarily developed to be used for pulmonary vein isolation (PVI). Also, there was no report regarding the isolation of LAA by using cryo-balloon in patients with focal AT. In this case, for the first time in the literature, we successfully isolated the LAA because of failed attempts of RF ablation for focal AT in whom the surface electrogram showed a sinus rhythm while arrhythmia continues inside the LAA.

| S-EPMC5784686 | biostudies-other

Which patients recur as atrial tachycardia rather than atrial fibrillation after catheter ablation of atrial fibrillation?

Project description:The ablation gaps have been known as the main mechanism of recurrence as atrial tachycardia (AT) rather than atrial fibrillation (AF) after AF catheter ablation. However, AF organization due to reduction of critical mass or focal trigger may also be the mechanism of AT recurrence. We sought to find out the main clinical factors of recurrence as AT rather than AF after AF ablation in the absence of antiarrhythmic drug effect.We analyzed 521 patients (70.8% men, 64.1% paroxysmal AF) who experienced AT or AF recurrence without antiarrhythmic drug effect during 44.7 ± 25.4 months follow-up.Among 521 patients with recurrence, 42.0% (219 of 521) recurred with AT. The proportion of AT recurrence was not different between the pulmonary vein isolation only group and additional linear ablation group (45.1% vs. 38.1%, p = 0.128). The absence of hypertension (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.29-0.83, p = 0.007), small left atrial (LA) volume index (OR 0.89 per 10 mL/m2, 95% CI 0.79-1.00, p = 0.049), and high mean LA bipolar voltage (OR 2.03 per 1 mV, 95% CI 1.30-3.16, p = 0.002) were independently associated with AT recurrence, whereas additional linear ablation was not. Among 90 patients who underwent repeat ablation procedure, rates of PV reconnection (p = 0.358) and gap in prior linear ablations (p = 0.269) were not significantly different between AT recurrence group and AF recurrence group.The degree of LA remodeling is significantly associated with recurrence as AT after AF ablation, irrespective of potential ablation gap in linear lesion.

| S-EPMC5690680 | biostudies-literature

Possible role for cryoballoon ablation of right atrial appendage tachycardia when conventional ablation fails.

Project description:Focal atrial tachycardia arising from the right atrial appendage usually responds well to radiofrequency ablation; however, successful ablation in this anatomic region can be challenging. Surgical excision of the right atrial appendage has sometimes been necessary to eliminate the tachycardia and prevent or reverse the resultant cardiomyopathy. We report the case of a 48-year-old man who had right atrial appendage tachycardia resistant to multiple attempts at ablation with use of conventional radiofrequency energy guided by means of a 3-dimensional mapping system. The condition led to cardiomyopathy in 3 months. The arrhythmia was successfully ablated with use of a 28-mm cryoballoon catheter that had originally been developed for catheter ablation of paroxysmal atrial fibrillation. To our knowledge, this is the first report of cryoballoon ablation without isolation of the right atrial appendage. It might also be an alternative to epicardial ablation or surgery when refractory atrial tachycardia originates from the right atrial appendage.

| S-EPMC4473632 | biostudies-literature

Right coronary artery compromise following radiofrequency catheter ablation for supraventricular tachycardia: cases reports.

Project description:BackgroundCoronary compromise is a serious potential complication following catheter ablation; however, procedural details in the literature are often lacking, preventing the identification of learning opportunities.Case summaryWe report two cases of right coronary compromise following catheter ablation for symptomatic supraventricular tachycardia. After radiofrequency energy delivery at the coronary sinus ostium in both cases, inferior lead ST-elevation was observed. Diagnostic coronary angiography identified an occluded posterior left ventricular branch of the coronary artery, and optical coherence tomography demonstrated a high thrombus burden at this location. Electrocardiographic ST-segments settled with implantation of a drug-eluting stent.DiscussionCoronary compromise was likely secondary to energy delivery during catheter ablation. This case series highlights the need for electrophysiologist to understand coronary anatomy relative to anatomical landmarks, to anticipate the risk of vascular injury as physical distance from the site of ablation is likely important. Risk for coronary compromise, while a rare complication, needs to be discussed with patients during the consenting process. We also demonstrate the importance of an efficient multi-disciplinary team process for managing acute procedural complications.

| S-EPMC10516517 | biostudies-literature

Prevalence and Characteristics of Atrial Tachycardia From Noncoronary Aortic Cusp During Atrial Fibrillation Catheter Ablation.

Project description:Background and objectivesAtrial tachycardias (ATs) from noncoronary aortic cusp (NCC) uncovered after radiofrequency ablation for atrial fibrillation (AF) are rarely reported. This study was conducted to investigate the prevalence and clinical characteristics of NCC ATs detected during AF ablation and compare their characteristics with de novo NCC ATs without AF.MethodsConsecutive patients who underwent radiofrequency catheter ablation for AF were reviewed from the multicenter AF ablation registry of 11 tertiary hospitals. The clinical and electrophysiological characteristics of NCC AT newly detected during AF ablation were compared with its comparators (de novo NCC AT ablation cases without AF).ResultsAmong 10,178 AF cases, including 1,301 redo ablation cases, 8 (0.08%) NCC AT cases were discovered after pulmonary vein isolation (PVI; 0.07% in first ablation and 0.15% in redo ablation cases). All ATs were reproducibly inducible spontaneously or with programmed atrial stimulation without isoproterenol infusion. The P-wave morphological features of tachycardia were variable depending on the case, and most cases exhibited 1:1 atrioventricular conduction. AF recurrence rate after PVI and NCC AT successful ablation was 12.5% (1 of 8). Tachycardia cycle length was shorter than that of 17 de novo ATs from NCC (303 versus 378, p=0.012). No AV block occurred during and after successful AT ablation.ConclusionsUncommon NCC ATs (0.08% in AF ablation cases) uncovered after PVI, showing different characteristics compared to de-novo NCC ATs, should be suspected irrespective of P-wave morphologies when AT shows broad propagation from the anterior interatrial septum.

| S-EPMC9257151 | biostudies-literature

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