TITLE:
Coronary sinus reentrant tachycardia after atrial fibrillation ablation: From bad to worse
AUTHORS:
Pietro Turco
KEYWORDS:
Atrial Flutter; Atrial Fibrillation; Transcatheter Ablation; Three-Dimensional Mapping
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.4 No.2,
February
7,
2014
ABSTRACT: Herein
we present a case of atrial tachycardia as a sequel of AF ablations. A
42-year-old man was admitted to our department because of a very symptomatic
tachycardia. The patient, because of paroxysmal AF and typical atrial flutter,
had been already submitted (three times) to ablation procedures in both left (pulmonary
vein insulation) and right atria (cavo-tricuspidal isthmus). During the
electrophysiological study, a huge and very fast atrial tachycardia was
induced: 230 ms cycle length, 1/1 atrio-ventricular conduction with the
ventricular rate of 260 bpm, complete left bundle branch block, and clinically
recognized by the patient. Four minutes later, a 2/1 AV conduction without
branch block permitted mapping and ablation. A high-density mapping around
isthmus and coronary sinus (CS) was performed. The analysis of the chronological activation clearly showed a circuit
propagation around the CS ostium with a very slow conduction in the anterior
zone enlightened by the tight color progression, and counterclockwise
activation of the right atrium lateral wall. In anterior zone of CS ostium
diastolic fragmented electrograms were detected. After preventing his position
localization, radiofrequency delivering (35 W) was effective to interrupt the
arrhythmia in 3 seconds. Energy delivering was continued to anchor the lesion
to the inferior vena cava. Confirmation of successful ablation was determined
by unsuccessful attempts at reinduction of the arrhythmia, in basal state and
during infusion of isoproterenol.