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Atrial Incisional Tachycardia Following Three Decades of Cardiac Surgery

Author : G. Yoga, M. Thein, E. Sen, M. Munawar, B. Hartono
Upload Date : 19-04-2018

Atrial reentrant tachycardia related to surgery for congenital heart disease or in term of incisional reentry tachycardia is common and sometimes is challenging to treat pharmacologically. The most common electrophysiological mechanism is macro reentry around a scar. In most cases these arrhythmias are incessant and drug refractory. Hence a radiofrequency ablation (RF) procedure is a effective treatment of such tachycardia. We present a 66-year-old female, complaining of recurrent palpitation, which occured 30 years after atrial septal defect closure surgery, and had been treated medically for 6 months. ECG during tachycardia showed supraventricular origin at rate of 233 bpm, with RP>PR interval and RP interval 110ms. Chest radiography and Echocardiography showed no remarkable parameters nor structural problems. Electrophysiology study set up and activation mapping using CARTO  3D visualized earliest activation signal at inferolateral of right atria with small re-entry circuit related to those area of probable surgical scars. A pair of linier ablations then applied on the inferolateral wall toward the IVC, and successfully rendered it non-inducible, which can easily be induced prior to ablation. The total procedural time was 70 minutes. No complication occurred following ablation and patient was discharged the next day. All was good on 1-week follow-up. The case shows 3D mapping system provides an excellent electroanatomic and activation map and also reliable monitoring of the ablation catheter. This system may save procedural and fluoroscopy time on diagnosis of incisional tachycardia with an anatomic circuit and provide identification from another type of SVT.

KEYWORDS : Insisional atrial tachycardia, arryhtmia, supraventricular tachycardia, post-cardiac surgery, reentrant tachycardia, 3D mapping.

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