Key result
Radiofrequency ablation successfully terminates incessant atrial tachycardia originating from a mid-high left atrial recess.
Why the study?
Regular narrow complex tachycardia with a normal ECG and structurally normal heart can present diagnostic challenges requiring detailed electrophysiology study and mapping.
Case Report (n=1)
No
This case demonstrates the successful mapping and ablation of a long R-P atrial tachycardia using ventricular overdrive pacing and extrastimuli to reveal P-wave morphology.
Para-Hisian atrial tachycardia can underlie long RP narrow-complex tachycardia; leaves open optimal ablation strategies in similar cases.
We present a case of regular narrow complex tachycardia in a 59-year-old woman with frequent paroxysmal palpitations, a normal electrocardiogram (ECG) in sinus rhythm, and a structurally normal heart. During electrophysiology study, a long R-P tachycardia was present at baseline, with P-waves superimposed on the T-waves and appearing to be positive in the inferior leads. Intracardiac recordings showed the atrial activation to be early in the para-Hisian region. The diagnosis of atrial tachycardia was confirmed by ventricular overdrive pacing, which showed ventriculoatrial dissociation without perturbing the atrial rate. The precise P-wave morphology was brought out in the pause, which followed rapidly delivered ventricular extrastimuli during tachycardia. Based on this information, activation mapping was conducted in the para-Hisian region, high atrial septal regions on the right and left sides, and aortic sinuses. Tachycardia was successfully ablated at one of these sites.
No takes yet. Share an insight, caveat, or question.
Vaishnav et al. (2021) conducted a case report in Atrial tachycardia (n=1). Radiofrequency ablation was evaluated on Termination of tachycardia. Radiofrequency ablation successfully terminated incessant atrial tachycardia originating from a recess in the mid-high left atrium close to the interatrial septum.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: