A case of biatrial tachycardia via the epicardial connection between right-sided pulmonary vein and right atrium

Figures

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  Figure 1. A: Twelve-lead electrocardiogram of the biatrial tachycardia (BiAT). B: Three-dimensional activation map of the right atrium during BiAT. The black tag indicates the sites with the approximated postpacing interval to the BiAT cycle length (within 10 ms). The yellow tag indicates the site of nonpacing capture. C: Three-dimensional voltage map of the left atrium during BiAT. D: Three-dimensional voltage map of the right atrium during BiAT.

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  Figure 2. Three-dimensional activation map of the right atrium (RA) and left atrium during biatrial tachycardia (BiAT). A: The 3-dimensional activation map indicated the downward propagation in the lateral wall of the RA (white solid arrow). The activation propagated from the RA to the inferior aspect of the right inferior pulmonary vein through the epicardial connection (EC) between the right-sided pulmonary vein and the RA (white dotted arrow). The black tag indicates the sites with the approximated postpacing interval (PPI) to the BiAT cycle length (CL) (within 20 ms). The yellow tag indicates the site with a prolonged PPI compared to the BiAT CL. The white tag indicates the earliest left atrium (LA) activation site. B: The 3-dimensional activation map indicates the upward propagation in the anterior wall of the LA (white solid arrow). The black tag indicates the sites with the approximated PPI to the BiAT CL (within 10 ms). C: The activation propagated from LA to RA through the Bachmann bundle (white solid arrow).

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  Figure 3. A: White arrow indicates the isolation area of the epicardial connection attachment site. B: Three-dimensional activation map of left atrium during pacing from the isolation area (A: blue tag). C: Three-dimensional activation map of left atrium during pacing beside the isolation area (A: green tag).