Utility of coherent and ripple mapping for post-mitral valve plasty biatrial macro-re-entrant tachycardia: a case report

Figures

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  Figure 1. Twelve-lead electrocardiogram. An atrial tachycardia with a tachycardia cycle length of 304 ms and positive P-waves in leads I, II, III, aVF, V4, V5, and V6 can be seen.

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  Figure 2. Electroanatomic mapping of atrial tachycardia. (A) In the activation map of the left atrium during atrial tachycardia, atrial tachycardia was suspected to localized re-entrant tachycardia in the anterior wall of the left atrium. (B) The coherent map of both atriums shows the propagation of the tachycardia circuit running from the right atrial high septum to the left atrial septum via an interatrial connection, and turning to the right atrial septum from the left atrial septum below the right superior pulmonary vein via the Bachmann bundle with clockwise rotation. The high-septum interatrial connection appears to have a conduction delay because conduction velocity vectors near the connection are thicker (red arrow) relative to the surrounding areas. Entrainment mapping shows a short post-pacing interval [tachycardia cycle length—(post-pacing interval) <20 ms] in right atrial septum and left atrial septum. (C) The voltage map shows a wide low-voltage zone extending from the left atrial anterior wall to the left and right atrial septums.

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  Figure 3. Left atrial activation map and intracardiac electrophysiology during atrial tachycardia. Clear double potentials can be seen at the site of the PentaRay catheter contact. The preceding potentials (①, ②, ③, ④) are epicardial potentials, while the following potentials (⑤, ⑥, ⑦) are left atrial endocardial potentials.

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  Figure 4. Intracardiac electrophysiology of successful ablation site. (A) Radiofrequency ablation was performed at the site of double potentials, which can be considered an interatrial connection on the high septum. (B) Biatrial tachycardia is terminated after 17 s of ablation and sinus rhythm is restored without pause.

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