Open AccessCatheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double‐Outlet Right Ventricle
Author(s) -
Wada Tadashi,
Watanabe Atsuyuki,
Koide Yuji,
Kagawa Kenzo,
Naito Yoichiro,
Tsushima Sho,
Toda Hironobu,
Kawada Satoshi,
Terasaka Ritsuko,
Nakahama Makoto,
Nagase Satoshi
Publication year - 2012
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/j.joa.2012.01.004
Subject(s) - medicine , cardiology , atrial tachycardia , atrial flutter , ventricle , catheter ablation , tachycardia , ablation
A 54‐year‐old man with a surgically repaired double‐outlet right ventricle (DORV) presented with palpitations and worsening right heart failure. His 12‐lead ECG showed atrial tachycardia (AT) with an atrial cycle length (CL) of 300 ms and an inverted saw‐tooth F‐wave pattern in the inferior leads II, III, and aVF typical of atrial flutter. Electrophysiological study and radiofrequency catheter ablation were performed. A total of 3 sustained ATs (AT1–AT3) were induced. Using the electroanatomical mapping system, CARTO3, and conventional mapping techniques, the ATs were identified as macroreentrant tachycardias circling around an incisional line on the free wall of the right atrium (AT1), the tricuspid annulus (AT2), and low voltage area in the lateral wall including the right septum (AT3). Accuracy of CARTO3 in three‐dimensional reconstruction was sufficient to elucidate anatomical features (including catheter sites, incision, and low voltage areas) and macroreentrant circuits. However, conventional mapping techniques were also necessary to identify the mechanism of the tachycardias, and therefore to eliminate all of them successfully. This case demonstrates that the use of combined conventional and electroanatomical mapping techniques, such as CARTO3, can be helpful in identifying the critical isthmus for catheter ablation of macroreentrant AT in patients with surgically corrected congenital heart disease (CHD).