Key result
RSPV isolation maintains sinus rhythm and symptom-free status at 3 years.
Why the study?
Paroxysmal atrial tachycardia can present with subtle P wave morphology changes without significant heart rate variation, complicating diagnosis and localization of ectopic foci.
Does right superior pulmonary vein isolation restore sinus rhythm and resolve symptoms in a patient with paroxysmal atrial tachycardia originating from the RSPV?
Case Report (n=1)
Does right superior pulmonary vein isolation restore sinus rhythm and resolve symptoms in a patient with paroxysmal atrial tachycardia originating from the RSPV?
Subtle changes in P wave morphology without significant heart rate changes can help diagnose and localize ectopic atrial tachycardia, which can be successfully treated with pulmonary vein isolation.
Variable-rate atrial ectopy may mimic regular rhythm; single case leaves open broader diagnostic validation.
Paroxysmal atrial tachycardia usually presents as a sudden acceleration of the atrial rate combined with modifications of the P wave morphology. A 22-year-old patient presented with very fast and very slow atrial ectopic activity. He complained of repetitive episodes of fast tachycardia, some accompanied with dizziness. When the ectopic discharge was slow, no clear-cut difference between the sinus rate and the ectopic rate was seen and thus the atrial rhythm appeared quite regular. The ectopic focus was situated deep inside the right upper pulmonary vein (RSPV). After RSPV isolation a persistent sinus rhythm was established and since then the patient has been asymptomatic for 3 years. Thus, subtle changes in the P wave morphology without a significant change in the heart rate in patients presenting with palpitations can give a clue to the diagnosis of the tachycardia and the localization of the ectopic focus.
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Verbeet et al. (2021) conducted a case report in Paroxysmal atrial tachycardia (n=1). Right superior pulmonary vein (RSPV) isolation was evaluated on Persistent sinus rhythm and asymptomatic status. Right superior pulmonary vein isolation established a persistent sinus rhythm and rendered the patient asymptomatic for 3 years.
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