Open AccessCatheter Ablation of a Complex Atrial Tachycardia after Surgical Repair of Tetralogy of Fallot Guided by Combined Noncontact and Contact Mapping
Author(s) -
Fujii Eitaro,
Senga Michiharu,
Sugiura Shinya,
Yamazato Shoichiro,
Nakanura Mashio,
Ito Masaaki
Publication year - 2010
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(10)80034-1
Subject(s) - crista terminalis , medicine , reentry , ablation , atrial tachycardia , tachycardia , cardiology , atrial flutter , inferior vena cava , catheter ablation , atrial fibrillation , surgery
A 34‐year‐old man with a surgically repaired Tetralogy of Fallot complained of palpitation, fatigue, and presyncope. A 12‐lead ECG showed atrial tachycardia with a cycle length of 250 ms and a P wave morphology positive in leads II, III and aVF, and negative in lead V1. Although the EnSite system (version 6.OJ) made use of noncontact mapping to delineate the counterclockwise reentry around the crista tenninalis, it was difficult to rule out the incisional atrial reentry because the location of the surgical incision was far from the multi‐electrode array. Since the bipolar contact mapping of the EnSite system revealed the location of the atriotomy incision, entrainment mapping during the tachycardia demonstrated the critical reentry circuit around the crista terminalis. Radiofrequency ablation targeting the critical isthmus from the lower position of the crista terminalis to the posterior dense scar which was continuous with the inferior vena cava, and to the atriotomy scar, eliminated the tachycardia.