Journal
INTERNAL MEDICINE
Volume 60, Issue 4, Pages 563-567Publisher
JAPAN SOC INTERNAL MEDICINE
DOI: 10.2169/internalmedicine.5361-20
Keywords
situs inversus totalis; cryoballoon ablation; multiple atrial tachycardia; small closely spaced electrodes; three-dimensional electroanatomic mapping system
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A 70-year-old woman with situs inversus totalis underwent catheter ablation for atrial fibrillation and atrial flutter. Multiple atrial tachycardias with complex anatomy were successfully treated using a three-dimensional electroanatomic mapping system. The presence of fragmented potentials in a limited area of the anterior morphologic left atrium and small-circuit reentry with extremely slow conduction were key factors in the treatment success.
A 70-year-old woman with situs inversus totalis underwent catheter ablation for atrial fibrillation and atrial flutter. Although her morphologic left atrium (LA) was enlarged, we performed cryoballoon ablation and liner radiofrequency ablation of the cava-tricuspid isthmus without mapping atrial arrhythmias. However, a different form of atrial tachycardia (AT) recurred. We performed catheter ablation a second time using a three-dimensional electroanatomic mapping system. AT was not terminated by the liner ablation at the roof of morphologic LA and mitral isthmus but sustained by changing the atrial activation sequence and cycle length. Multipolar mapping catheter revealed that fractionated low-amplitude potentials were densely located in a limited area of the anterior morphologic LA, and an activation map demonstrated the presence of small-circuit reentry with an extremely slow conduction at the anterior morphologic LA. A single energy application targeting the fragmented potentials successfully terminated the AT. We successfully treated multiple ATs with a complex anatomy using a three-dimensional electroanatomic mapping system.
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