Key result
High-density mapping using a PentaRay catheter successfully identified a micro-reentrant atrial tachycardia originating from the fossa ovalis, which was effectively terminated by radiofrequency ablation with no recurrence at 12 months.
Why the study?
Micro-reentry tachycardia usually emerges in scar tissues, and it is difficult to accurately identify the circuit using conventional mapping methods.
Case Report (n=1)
No
High-density mapping with a PentaRay catheter can effectively characterize and guide successful ablation of unusual micro-reentrant atrial tachycardias originating from the fossa ovalis in patients without prior ablation or cardiomyopathy.
May guide ablation of rare fossa ovalis micro-reentry; hypothesis-generating and requires prospective validation before broader adoption.
BACKGROUND: Micro-reentry tachycardia usually emerges in scar tissues related to post-atrial fibrillation ablation and cardiomyopathy. It is difficult to identify the micro-reentry circuit accurately by conventional mapping method. CASE SUMMARY: A 74-year-old man presented with paroxysmal atrial tachycardia (AT) presenting as palpitations. He was evaluated by an electrophysiological examination using a high-density CARTO mapping system. The mapping results showed the AT with a cycle length of 184 ms was focused on his right atrial fossa ovalis (FO). In this small area, the high-density mapping demonstrated a significant micro-reentrant tachycardia. Radiofrequency ablation at the centre of the micro-reentrant circuit successfully terminated the AT. No recurrences were observed during a 12-month follow-up. DISCUSSION: This case demonstrated a micro-reentrant AT originates from the FO without cardiomyopathy or previous ablation with specific loops. This is an unusual location for AT though and can cause difficulty for operators if it terminates or is non-sustained. High-density mapping using a PentaRay catheter can effectively characterize micro-reentrant circuits and determine the real target for ablation therapy.
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Li et al. (2019) conducted a case report in Paroxysmal atrial tachycardia (n=1). High-density mapping and radiofrequency catheter ablation was evaluated on Termination of atrial tachycardia and recurrence. High-density mapping using a PentaRay catheter successfully identified a micro-reentrant atrial tachycardia originating from the fossa ovalis, which was effectively terminated by radiofrequency ablation with no recurrence at 12 months.
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