Peri-Mitral Atrial Tachycardia Following Transcatheter Aortic Valve Replacement

Figure 1. The 12-Lead Electrocardiogram of Atrial Tachycardia P waves are evident in lead II (emphasized by arrows in the inset).

Figure 2. Re-Entrant Circuit of the Tachycardia The tachycardia cycle length was fully covered within the left atrium (LA). Entrainment study demonstrated post pacing interval–tachycardia cycle lengths were within 20 ms around the mitral annulus (values are shown in the white boxes) while that was off at the posterior wall of the LA, demonstrating that the tachycardia was peri-mitral atrial tachycardia. AP = anterior to posterior; PA = posterior to anterior.

Figure 3. The Relationship Between Arrhythmogenic Substrate of PMT and TAVR Valve (A) The atrial tachycardia (AT) was diagnosed as counterclockwise peri-mitral AT (annotated with colored arrows; orange, slowly conducting atrial wall, yellow, the rest of the circuit). For details regarding the diagnostic process, see the main text. Slowly conducting, fragmented local electrogram is shown in the inset. SC = slow conduction; LAO-CAU = left anterior oblique–caudal; TCL = tachycardia cycle length. (B) Low-voltage area (in red, yellow, green, and other non-purple colors) indicated by white arrows. The SC zone shown in (A) is indicated with an orange dot. (C) Spatial relationship between the low-voltage area and ascending aorta. The SC zone shown in (A) is indicated with an orange dot. AP = anterior to posterior. (D) AT termination during ablation from the epicardial side of the mitral isthmus. Subsequently, the line of conduction block was confirmed by differential pacing and a 3-dimensional map (not shown) and no AT or atrial fibrillation was induced. (E) Computed tomography images at the level of the anterior left atrial (LA) wall before (left) and after (right) transcatheter aortic valve…