Open AccessNoncontact Mapping‐Guided Catheter Ablation of Posterosuperior Right Atrial Tachycardia Associated with Sick Sinus Syndrome
Author(s) -
Yasuda Shioto,
Nakamura Hirofumi,
Karashima Eiji,
Ueda Jin,
Nakaji Gen,
Shimazu Hideki,
Hiramatsu Shinichi,
Odashiro Keita,
Maruyama Toru,
Kaji Yoshikazu
Publication year - 2008
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/s1880-4276(08)80005-1
Subject(s) - medicine , sick sinus syndrome , cardiology , ablation , catheter ablation , presyncope , ambulatory , sinus rhythm , tachycardia , sinus (botany) , atrial tachycardia , atrial fibrillation , heart rate , blood pressure , botany , biology , genus
Focal atrial tachycardia (AT) is sometimes associated with sick sinus syndrome. A 57‐year‐old female complained of palpitation, fatigue and presyncope. Ambulatory monitoring demonstrated frequent segments of AT and subsequent sinus arrests. P wave morphology of ectopic beats was similar to that of sinus rhythm. After obtaining diagnosis of bradycardia tachycardia syndrome, she underwent electrophysiologic study (EPS) and radiofrequency (RF) catheter ablation to eliminate AT. Conventional EPS could not be performed due to frequent spontaneous ectopic beats. EnSite mapping demonstrated that AT originates from posterosuperior right atrium (RA) and that local electrogram of ectopic focus precedes the onset of P wave in surface ECG by 40 msec. After EnSite‐guided RF ablation to the target area, ambulatory monitoring detected no AT or sinus arrest. EPS performed one week after RF ablation showed atropine‐induced partial restoration of sinus node dysfunction. Her symptoms were resolved remarkably and permanent pacemaker implantation has not been necessary to date. RF ablation guided by EnSite mapping was useful to eliminate AT arising from limited ectopic focus and this case implies existence of “pacemaker‐avoidable” bradycardia tachycardia syndrome.