Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle
A 54-year-old man with a surgically repaired double-outlet right ventricle (DORV) presented with palpitations and worsening right heart failure. His 12-lead ECG showed atrial tachycardia (AT) with an atrial cycle length (CL) of 300 ms and an inverted saw-tooth F-wave pattern in the inferior leads II...
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| Format: | Article |
| Language: | English |
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Wiley
2012-06-01
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| Series: | Journal of Arrhythmia |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1880427612000488 |
| _version_ | 1819111739041513472 |
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| author | Tadashi Wada Atsuyuki Watanabe Yuji Koide Kenzo Kagawa Yoichiro Naito Sho Tsushima Hironobu Toda Satoshi Kawada Ritsuko Terasaka Makoto Nakahama Satoshi Nagase |
| author_facet | Tadashi Wada Atsuyuki Watanabe Yuji Koide Kenzo Kagawa Yoichiro Naito Sho Tsushima Hironobu Toda Satoshi Kawada Ritsuko Terasaka Makoto Nakahama Satoshi Nagase |
| author_sort | Tadashi Wada |
| collection | DOAJ |
| description | A 54-year-old man with a surgically repaired double-outlet right ventricle (DORV) presented with palpitations and worsening right heart failure. His 12-lead ECG showed atrial tachycardia (AT) with an atrial cycle length (CL) of 300 ms and an inverted saw-tooth F-wave pattern in the inferior leads II, III, and aVF typical of atrial flutter. Electrophysiological study and radiofrequency catheter ablation were performed. A total of 3 sustained ATs (AT1–AT3) were induced. Using the electroanatomical mapping system, CARTO3, and conventional mapping techniques, the ATs were identified as macroreentrant tachycardias circling around an incisional line on the free wall of the right atrium (AT1), the tricuspid annulus (AT2), and low voltage area in the lateral wall including the right septum (AT3). Accuracy of CARTO3 in three-dimensional reconstruction was sufficient to elucidate anatomical features (including catheter sites, incision, and low voltage areas) and macroreentrant circuits. However, conventional mapping techniques were also necessary to identify the mechanism of the tachycardias, and therefore to eliminate all of them successfully. This case demonstrates that the use of combined conventional and electroanatomical mapping techniques, such as CARTO3, can be helpful in identifying the critical isthmus for catheter ablation of macroreentrant AT in patients with surgically corrected congenital heart disease (CHD). |
| first_indexed | 2024-12-22T04:02:24Z |
| format | Article |
| id | doaj.art-9c0146ab2e8241fdaa8b6c2ffa3ce499 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 |
| language | English |
| last_indexed | 2024-12-22T04:02:24Z |
| publishDate | 2012-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-9c0146ab2e8241fdaa8b6c2ffa3ce4992022-12-21T18:39:42ZengWileyJournal of Arrhythmia1880-42762012-06-0128319620110.1016/j.joa.2012.01.004Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right VentricleTadashi Wada0Atsuyuki Watanabe1Yuji Koide2Kenzo Kagawa3Yoichiro Naito4Sho Tsushima5Hironobu Toda6Satoshi Kawada7Ritsuko Terasaka8Makoto Nakahama9Satoshi Nagase10Department of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiology, Fukuyama City Hospital, Hiroshima, JapanDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JapanA 54-year-old man with a surgically repaired double-outlet right ventricle (DORV) presented with palpitations and worsening right heart failure. His 12-lead ECG showed atrial tachycardia (AT) with an atrial cycle length (CL) of 300 ms and an inverted saw-tooth F-wave pattern in the inferior leads II, III, and aVF typical of atrial flutter. Electrophysiological study and radiofrequency catheter ablation were performed. A total of 3 sustained ATs (AT1–AT3) were induced. Using the electroanatomical mapping system, CARTO3, and conventional mapping techniques, the ATs were identified as macroreentrant tachycardias circling around an incisional line on the free wall of the right atrium (AT1), the tricuspid annulus (AT2), and low voltage area in the lateral wall including the right septum (AT3). Accuracy of CARTO3 in three-dimensional reconstruction was sufficient to elucidate anatomical features (including catheter sites, incision, and low voltage areas) and macroreentrant circuits. However, conventional mapping techniques were also necessary to identify the mechanism of the tachycardias, and therefore to eliminate all of them successfully. This case demonstrates that the use of combined conventional and electroanatomical mapping techniques, such as CARTO3, can be helpful in identifying the critical isthmus for catheter ablation of macroreentrant AT in patients with surgically corrected congenital heart disease (CHD).http://www.sciencedirect.com/science/article/pii/S1880427612000488Macroreentrant atrial tachycardiaDouble-Outlet Right VentricleCARTO3 systemRadiofrequency ablationConventional mapping techniques |
| spellingShingle | Tadashi Wada Atsuyuki Watanabe Yuji Koide Kenzo Kagawa Yoichiro Naito Sho Tsushima Hironobu Toda Satoshi Kawada Ritsuko Terasaka Makoto Nakahama Satoshi Nagase Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle Journal of Arrhythmia Macroreentrant atrial tachycardia Double-Outlet Right Ventricle CARTO3 system Radiofrequency ablation Conventional mapping techniques |
| title | Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle |
| title_full | Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle |
| title_fullStr | Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle |
| title_full_unstemmed | Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle |
| title_short | Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle |
| title_sort | catheter ablation of three macroreentrant atrial tachycardias after surgical repair of double outlet right ventricle |
| topic | Macroreentrant atrial tachycardia Double-Outlet Right Ventricle CARTO3 system Radiofrequency ablation Conventional mapping techniques |
| url | http://www.sciencedirect.com/science/article/pii/S1880427612000488 |
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