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Supraventricular bigeminy originating from the mitral annulus: What is the mechanism?
Author(s) -
Yokoyama Masaaki,
Yamashita Seigo,
Tokuda Michifumi,
Mahida Saagar,
Yoshimura Michihiro,
Yamane Teiichi
Publication year - 2020
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/jce.14645
Subject(s) - bigeminy , medicine , supraventricular arrhythmia , cardiology , pulmonary vein , mitral annulus , atrial fibrillation , sinus rhythm , diastole , blood pressure , ventricular tachycardia
We present a case of a 67‐year‐old female with a previous history of pulmonary vein isolation for paroxysmal atrial fibrillation who presented with supraventricular bigeminy with a constant coupling interval. The supraventricular bigeminy originated from the anterior mitral annulus with initial mapping suggestive of a focal mechanism. However detailed mapping using an ultrahigh resolution mapping system (with the manual shifting of the annotation window) revealed very low amplitude potentials connecting the previous sinus beat with continuous activation along the mitral annulus. Our observations were indicative of a re‐entry mechanism underlying the supraventricular bigeminy.