Open AccessAdenosine Triphosphate‐sensitive Micro‐reentrant Atrial Tachycardia Originating from the Crista Terminalis in a Patient with Chronic Renal Failure due to Thrombotic Thrombocytopenic Purpura
Author(s) -
Sugiura Shinya,
Fujii Eitaro,
Senga Michiharu,
Matsuo Koji,
Tanoue Akiko,
Murata Tomohiro,
Ishikawa Eiji,
Tamada Hiroya,
Nakamura Mashio,
Nomura Shinsuke,
Ito Masaaki
Publication year - 2009
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(09)80004-5
Subject(s) - medicine , crista terminalis , tachycardia , cardiology , atrial tachycardia , atrioventricular reentrant tachycardia , anesthesia , catheter ablation , accessory pathway , ablation
A 57‐year‐old woman with chronic renal failure due to the thrombotic thrombocytopenic purpura complained of palpitation. A 12‐lead ECG showed supraventricular tachycardia with a cycle length of 375 ms. During the electrophysiological study, a tachycardia with a cycle length of 375 ms was reproducibly induced and terminated by atrial extrastimulation. The tachycardia exhibited an inverse relationship between the coupling interval of extrastimulus initiating the tachycardia, and the first postpacing return cycle, as well as an increasing pattern of resetting the tachycardia with an atrial extrastimulus. Ventricular burst pacing during tachycardia produced AV dissociation. Intravenous injections of a low dose (4 mg) of adenosine triphosphate (ATP) terminated the tachycardia without a preceding atrio‐His bundle block. The tachycardia was diagnosed as an ATP‐sensitive micro‐reentrant atrial tachycardia. Real‐time endocardial activation mapping using an electroanatomical mapping system revealed that the earliest activation site of the tachycardia was located at the midlateral portion of the crista terminalis. The tachycardia was abolished by focal ablation targeting the earliest activation site during tachycardia. This is the first reported case of an ATP‐sensitive micro‐reentrant atrial tachycardia associated with thrombotic thrombocytopenic purpura.