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Case Reports
. 2022 Sep 2;8(11):776-780.
doi: 10.1016/j.hrcr.2022.08.011. eCollection 2022 Nov.

Open-window mapping of atriofascicular tachycardia

Joshua Aymond  1 , Walter J Hoyt Jr  2 , Patricia E Thomas  2 , Thomas Young  2 , Daniel P Morin  1 , Michael L Bernard  1
Affiliations
Case Reports

Open-window mapping of atriofascicular tachycardia

Joshua Aymond et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Adult congenital heart disease; Atriofascicular pathway; Atriofascicular tachycardia; Ebstein anomaly; Open-window mapping.

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Figures

Figure 1
Figure 1
A: Baseline 12-lead electrocardiogram (ECG). B: Twelve-lead ECG of the clinical tachycardia. Time scale is 100 ms per tick mark.
Figure 2
Figure 2
A: Atriofascicular potentials (red arrows) along the distal, lateral right ventricle during tachycardia. HD grid electrograms (from top to bottom) are A1-A3, AB1-AB3, B1-B3, BC1-BC3, C1-C3, CD1-CD3, and D1-D3. Two-letter, one-number electrograms represent bipoles from 2 adjacent HD grid electrodes. AB1 represents a bipole between A1 and B1. CS electrograms (from top to bottom) are proximal to distal. B, left: Left anterior oblique and right anterior oblique local activation timing maps of the clinical tachycardia. Color scale of the activation map is shown (left), with white representing electrograms that precede onset of the QRS. B, right: Electrograms from the HD grid at the area of earliest ventricular activation.
Figure 3
Figure 3
A: Left lateral view with EnSite Omnipolar Technology (OT) showing retrograde septal activation progressing up the right ventricular (RV) septum and through the right bundle branch to the atrioventricular (AV) node. Lower left: His catheter, with recordings. Yellow arrow shows retrograde His-bundle activation, consistent with the diagnosis of AV reciprocating tachycardia. Lower right: Retrograde activation with OT vectors in the area of the His bundle and AV node. B, left: Right anterior oblique view with EnSite OT vectors showing earliest ventricular activation along the distal, lateral RV. B, right: Close-up of the earliest area of ventricular activation (yellow box) showing several areas of early ventricular activation (white) consistent with arborization of the distal fascicle as it inserts into the ventricle. Dashed circle shows radial spread of local activation, annotated by omnipolar vectors, away from an area near the earliest ventricular activation. C: Successful ablation during tachycardia at a site just basal to the site of earliest ventricular activation (blue dot within yellow circle) after 5.2 seconds of ablation. Top: Electrogram on the ablation catheter at the initial and effective lesion. Note the fascicular potential (red arrows) and presystolic ventricular electrogram at the effective site of termination.
See this image and copyright information in PMC

References

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