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Case Reports
. 2023 May 15;14(5):5436-5441.
doi: 10.19102/icrm.2023.14052. eCollection 2023 May.

Atrial Tachycardia with Cycle Length Alternans

Ahmet Korkmaz  1 , Özcan Özeke  1 , Serkan Cay  1 , Firat Ozcan  1 , Meryem Kara  1 , Elif Hande Ozcan Cetin  1 , Nur Beton  1 , Atik Aksoy  1 , Halenur Saribas  1 , Idriz Merovci  2 , Can Demirhan  1 , Dursun Aras  3 , Serkan Topaloglu  1
Affiliations
Case Reports

Atrial Tachycardia with Cycle Length Alternans

Ahmet Korkmaz et al. J Innov Card Rhythm Manag. .

Abstract

Tachycardia-induced tachycardia, or so-called double tachycardia, appears to be a relatively rare condition. The underlying mechanism for stable beat-to-beat cycle length variability (alternans) in atrial tachycardia has been sparsely reported.

Keywords: Atrial tachycardia; double tachycardia; dual loop; multiple loops.

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Conflict of interest statement

The authors report no conflicts of interest for the published content. No funding information was provided.

Figures

Figure 1:
Figure 1:
Electrocardiography showing the supraventricular tachycardia with cycle length alternans.
Figure 2:
Figure 2:
The electroanatomic map of the left atrium from the posterior view with (A) coherent mapping and (B) voltage mapping shows a focal site of earliest activation from the right inferior pulmonary vein spreading in all directions after posterior exit.
Figure 3:
Figure 3:
The electroanatomic map of the left atrium from the anterior view with (A) voltage mapping and (B) intracardiac electrography. Parallel mapping for (C) the CL-2 atrial tachycardia and (D) the alternating tachycardia. The change in the intracardiac electrograms preceded the tachycardia cycle length, particularly in the proximal coronary sinus (see channels 13 and 17). Note that the longer conduction time depicted by fragmentation in the isthmus (area 13) was associated with lateness, causing color changes in area 17 and suggesting the competing activation between both tachycardias and passive circuits.
Figure 4:
Figure 4:
Note that the alternating of the double potentials and single or fragmented potentials corresponded to the cycle length alternans at a fixed location.
Figure 5:
Figure 5:
A and B: The left atrial anteroseptal roof site was considered to be in the re-entrant circuit based on the short post-pacing intervals.
See this image and copyright information in PMC

References

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