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Case Reports
. 2021 Jan 15;12(1):4372-4374.
doi: 10.19102/icrm.2021.120103. eCollection 2021 Jan.

A Hidden Recess of Atrial Tachycardia

Aditi S Vaishnav  1 , Aniruddha Vyas  2 , Yash Lokhandwala  3
Affiliations
Case Reports

A Hidden Recess of Atrial Tachycardia

Aditi S Vaishnav et al. J Innov Card Rhythm Manag. .

Abstract

We present a case of regular narrow complex tachycardia in a 59-year-old woman with frequent paroxysmal palpitations, a normal electrocardiogram (ECG) in sinus rhythm, and a structurally normal heart. During electrophysiology study, a long R-P tachycardia was present at baseline, with P-waves superimposed on the T-waves and appearing to be positive in the inferior leads. Intracardiac recordings showed the atrial activation to be early in the para-Hisian region. The diagnosis of atrial tachycardia was confirmed by ventricular overdrive pacing, which showed ventriculoatrial dissociation without perturbing the atrial rate. The precise P-wave morphology was brought out in the pause, which followed rapidly delivered ventricular extrastimuli during tachycardia. Based on this information, activation mapping was conducted in the para-Hisian region, high atrial septal regions on the right and left sides, and aortic sinuses. Tachycardia was successfully ablated at one of these sites.

Keywords: Mapping; supraventricular tachycardia; unipolar signals.

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Conflict of interest statement

The authors report no conflicts of interest for the published content.

Figures

Figure 1:
Figure 1:
A: Twelve-lead ECG of long R–P narrow complex tachycardia. B: Intracardiac electrograms during tachycardia. C: Ventricular overdrive pacing during tachycardia. Shown here are surface ECG leads as well as intracardiac electrograms. CS: coronary sinus (higher numbers mean proximal electrodes); ECG: electrocardiogram; HISP/D: His bundle proximal and distal. Higher numbers mean more proximal electrodes.
Figure 2:
Figure 2:
A: Twelve-lead ECG during rapidly delivered ventricular extrastimuli to bring out P-wave morphology (red rectangle). B: Signals at the noncoronary sinus as seen in the RFD/P/U channels. C: Signals at the site of successful ablation as seen in the RFD/P/U channels. Shown here are surface ECG leads as well as intracardiac electrograms. CS: coronary sinus (higher numbers mean proximal electrodes); ECG: electrocardiogram; HISP/D: His bundle proximal and distal; RFD/P/U ablation catheter distal, proximal, and unipolar.
Figure 3:
Figure 3:
A: Twelve-lead ECG during radiofrequency energy delivery. B,C: Anteroposterior and left anterior oblique fluoroscopic views showing the ablation site (arrow).
See this image and copyright information in PMC

References

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