Open AccessAtrial tachycardia caused by a superior vena cava fibrillation with conduction block
Author(s) -
Nozoe Masatsugu,
Koyama Junjiroh,
Honda Toshihiro,
Nakao Koichi
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.2012.05.005
Subject(s) - medicine , atrial fibrillation , cardiology , tachycardia , atrial tachycardia , superior vena cava , fibrillation , atrium (architecture) , electrophysiology study , electrophysiology , anesthesia , catheter ablation
AT caused by SVC fibrillation Here, we report a case of a 62‐year‐old man with a history of incessant atrial tachycardia (AT) for several years. An electrophysiological study revealed rapid and irregular activity in the superior vena cava (SVC), but the surface 12‐lead electrocardiogram (ECG) exhibited a relatively regular AT (atrial cycle length=240 ms). CARTO mapping of the right atrium (RA) demonstrated that the earliest atrial activation occurred at the posterior septum of the upper RA (the SVC–RA junction). Intravenous administration of 20 mg adenosine triphosphate (ATP) led to an acceleration of the SVC–RA conduction up to 1:1 conduction, and the atrial cycle length decreased, consequently converting the AT to transient atrial fibrillation (AF). Application of single radiofrequency energy at the earliest atrial activation site during tachycardia terminated the AT and achieved isolation of the SVC from the RA, despite the continued presence of fibrillation in the SVC. We speculated that SVC fibrillation with spontaneous conduction block at the SVC–RA junction was the cause of this AT.