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Atrial Tachycardia Originating from the Upper Left Atrial Septum: Demonstration of Transseptal Interatrial Conduction Using the Infolded Atrial Walls
Author(s) -
KUMAGAI KOJI,
SUZUKI FUMIO,
AONUMA KAZUTAKA,
SHIMOKAWA HIROAKI
Publication year - 2006
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2006.00518.x
Subject(s) - medicine , interatrial septum , atrial septum , cardiology , fossa ovalis , p wave , tachycardia , atrial tachycardia , heart septum , anatomy , atrial fibrillation , left atrium , catheter ablation
We report a rare case of atrial tachycardia (AT) originating from the upper left atrial septum. Electroanatomic mapping of both atria demonstrated that the earliest atrial activation during AT occurred at the upper left atrial septum 26 msec before the onset of the P wave, followed by the mid‐right atrial septum (10 msec before the onset of the P wave) and then the upper right atrial septum just adjacent to the left septal AT site (1 msec before the onset of the P wave), indicating detour pathway conduction from the upper left to the upper right atrium. Embryologically, it was suggested that the superior components of the secondary atrial septum are made by the infolded atrial walls and could develop a transseptal detour pathway involving the left‐side atrial septal musculature, the superior rim of the oval fossa and the right‐side atrial septal musculature. A single radiofrequency application targeting the upper left atrial septum successfully abolished the AT.