This case demonstrates that lower loop reentrant atrial tachycardia can develop late after surgical division of right-sided accessory pathways and can be successfully treated with cavotricuspid isthmus ablation.
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CTI ablation may terminate late post-surgical lower loop reentry; leaves open generalizability and need for prospective validation.
A 50-year-old man developed a symptomatic tachyarrhythmia 22 years after surgical division of multiple right-sided accessory pathways. Electro-anatomical mapping during sinus rhythm revealed an electrically isolated ectopic focus on the right atrial free wall near the tricuspid annulus (TA). Activation map during tachycardia indicated the presence of lower loop reentry (LLR) with collision of the wavefronts in the high right atrium. The isthmus of slow conduction was located between the surgical incision near the posterior TA and the inferior vena cava. LLR was eliminated by radiofrequency linear ablation at the cavotricuspid isthmus.
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Oginosawa et al. (2011) studied this question.
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