Abstract 11080: A Young Woman with Incessant Left Atrial Tachycardia
| Autor: | Banveet K Khetarpal, Binna M Chokshi, Sadaf Fakhra, Arjun Gururaj |
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| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | Circulation. 144 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | Introduction: Left atrial tachycardia (AT) is uncommon and usually does not occur in the absence of congenital heart disease, or prior catheter ablation (CA). Case: A 29-year-old woman with a 2-year history of SVT refractory to metoprolol and no prior CA presented to the emergency department with palpitations. Initial ECG showed a regular, narrow complex, short RP tachycardia, at 180 bpm, insensitive to adenosine and 2 electrical cardioversions. Echocardiogram showed LVEF of 40%. The patient underwent an entirely non-fluoroscopic electrophysiology study using intracardiac echocardiography and electroanatomic mapping (EAM). AT (cycle length 300 ms) was induced by programmed atrial stimulation with isoproterenol infusion. AT was confirmed with ventriculo-atrial dissociation after pacing maneuvers and adenosine administration. Right atrial (RA) activation map revealed early atrial activation in the mid coronary sinus (CS), raising suspicion of a left atrial (LA) origin. LA was accessed via transseptal puncture. The site of earliest atrial activation was in the LA wall inferior to the left inferior pulmonary vein (LIPV) ostium and was successfully terminated with radiofrequency ablation (40 W, 5 to 10 g) (Figure) with no further inducibility. The patient's symptoms resolved after the procedure. Discussion: Left AT usually originates from PVs or the atrial wall. The EAM in this patient showed centrifugal activation consistent with a focal mechanism. Adenosine is generally not helpful in terminating AT but is useful in diagnosis. Rapid conduction across the LA to CS may have given rise to early activation in the mid CS on RA mapping. However, LA mapping revealed that atrial activation was earliest in the LA wall inferior to the LIPV. Conclusion: AT is unusual in young, healthy women. A high index of suspicion to perform transseptal puncture can lead to successful ablation of AT with LA origin. We surmise that the patient’s EF may improve with termination of the tachycardia. |
| Databáze: | OpenAIRE |
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