Entrapment of focal atrial tachycardia using cryoballoon ablation; Sinus rhythm in the left atrium and ongoing atrial tachycardia in the left atrial appendage

Figures

• 

  Fig. 1. (A) CARTO map demonstrating earliest activation in the distal portion of LAA. (B) Simultaneous recordings of the left atrial appendage and coronary sinus catheter in the patient with ongoing AT. Intracardiac electrograms showed atrial tachycardia with the earliest activation in the distal CS tachycardia (cycle length: 540 msec) which was conducted to the left atrium (cycle length: 540 msec) and map catheter inside the LAA had the earliest atrial activation. (C) Fluoroscopic image of the CB ablation of LAA. (D) Termination of tachycardia in the left atrium and change in the activation pattern of coronary sinus catheter despite the ongoing tachycardia in the LAA. Dissociated AT originating from the LAA (arrows) during sinus rhythm in the rest of the atrium (cycle length: 620 msn).

• 

  Fig. 2. Intravenous adenosine (30 mg) was given after the CB isolation of LAA in order to determine the dormant conduction. Adenosine terminated LAA tachycardia as well as the AV conduction (asterisk). After the end of adenosine effect, LAA tachycardia resumes again with a cycle length of 540 msec, whereas the rhythm was sinus in the rest of the atrium.