Isolated Atrial Amyloidosis Suspected by Electrophysiological Voltage Mapping and Diagnosed by 99mTc-DPD Scintigraphy

Figures

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  Figure 1. (A) Patient's 12‐lead electrocardiogram showing ectopic atrial tachycardia cycle length (CL) 300 ms with Wenckebach pattern ventricular conduction. (B) Patient's sinus rhythm 12‐lead electrocardiogram with 48 b.p.m.

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  Figure 2. The patient's atrial substrate detected by voltage mapping and the consequential atrial tachycardias treated with catheter ablation. (A) Procedure 1: electroanatomic voltage and activation maps of the left atrium with Carto® (bipolar voltage 0.5–1.5 mV) in different views showing focal left atrial tachycardia from the anterior roof. Successful ablation site is shown by Visitag ablation points and the EGM. (B) Procedure 2: electroanatomic voltage and activation maps with Carto® (bipolar voltage 0.5–1.5 mV) in different views showing focal right atrial tachycardia from the high posterior wall (AT 1) and a second posteroseptal right atrial tachycardia; successful ablation sites are shown by Visitag ablation points. AP/sup, anterior with superior angulation; CL, cycle length; LA, left atrium; LL, left lateral; PA, posteroanterior; RA, right atrium. White arrows show tachycardia origins.

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  Figure 3. Atrial amyloidosis suspected by cardiac imaging with MRI and 99mTc scintigraphy. (A) Cardiac MRI (3T, gradient echo imaging) with circumferential late gadolinium enhancement of the left atrium (LA), no left ventricular hypertrophy, thrombus formation lining roof, and inferolateral wall. (B) DPD scan with technetium 99m showing infiltration of the LA. No uptake in the ventricular myocardium, no extra‐cardiac uptake, and slightly pronounced osseous uptake due to double‐sided omarthrosis and coxarthrosis. 3CH, three chamber view; 4CH, four‐chamber view.

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  Figure 4. Atrial strain analysis of the patient. (A) Cardiac MRI atrial strain analysis and global functional strain parameters compared with a historic control group. (B) Cardiac echocardiography showing pathological 2D left atrial strain in a four‐chamber view. 4Ch/2Ch, 4 or 2 chamber view; AVC, aortic valve closure; LA, left atrium; MVO, mitral valve opening; RA, right atrium.