Right atrial appendage tachycardia: A rare cause of tachycardia induced cardiomyopathy in a 4-year-old child

Figures

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  Fig. 1. (A) Shows a regular narrow QRS tachycardia noted in the 4-year-old child with features of heart failure; (B) shows the positive P waves in leads II, III (downward arrows) and negative P waves in leads avR and V1 (upward arrow), also seen is the slow P wave progression across the chest leads. The ventricle was overdrive paced as seen in the first half of the ECG; (C) shows the intra-cardiac signals. The HIS catheter is being utilized for ventricular overdrive pacing. Atrial signals in the CS catheter show an atrial tachycardia cycle length of 310 m s. The atrial bipolar signals at the RF catheter, which is placed near the right atrial appendage (RAA), reveals early signals with respect to the onset of P wave on the surface ECG; (D) shows 3D signals and ablation of RA appendage tachycardia using NavX Precision system (St. Jude Medical, St. Paul, MN, USA). Isochronal activation map has been constructed during tachycardia using proximal CS atrial signal as a reference. The RAA and the right atrium is seen in the RAO view (first half) and the left lateral view (second half). The color-coded display of the activation time in the right atrium measured relative to the reference point…

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  Fig. 2. (A) Shows termination 3D mapping and ablation of RA appendage tachycardia using NavX Precision system (St. Jude Medical, St. Paul, MN, USA). The termination of the atrial tachycardia was at the base of the right atrial appendage; (B) shows the angiogram of right atrial appendage using a pig-tail catheter in the RAO projection ruling out aneurysms and the position of the ablation catheter denotes the site of successful ablation at the superior base of the RAA; (C) 12-lead ECG shows the return of sinus rhythm after the ablation.