Organised Atrial Arrhythmias after Atrial Fibrillation Ablation in the Left Atrium (Example 2): Association of Multiple Potentially Pro-arrhythmogenic Factors Resulting in a Tachycardia with a Longer Cycle Length
This is a 66-year-old male patient with ischemic heart disease and prior inferior myocardial infarction with stenting of the left circumflex coronary artery. Three years before the current procedure, he underwent surgical mitral valvuloplasty for mitral regurgitation. For postoperative recurrent episodes of atrial fibrillation, amiodarone administration was initiated but was withdrawn after a few months due to hyperthyroidism. Then, two years before the current procedure, the patient underwent two procedures at another centre for catheter ablation of atrial fibrillation in the left atrium. Detailed descriptions of those procedures and of the surgical intervention could not be obtained. However, prior surgery did not imply any intraoperative ablation for atrial fibrillation. Subsequently, based on evidence of poor left ventricular function (ejection fraction 33%), a dual-chamber cardioverter-defibrillator was implanted by another centre. In the months before the procedure, the patient had episodes of atrial tachycardia causing congestive heart failure. This tachycardia had a 410 ms cycle length (with frequent 1:1 atrioventricular conduction periods) and a low-voltage P wave, negative in the inferior leads, positive in V1, flat in all the other leads (Fig. 1). For this reason, the patient was referred for catheter ablation of the arrhythmia.
KeywordsAtrial Fibrillation Pulmonary Vein Left Atrium Atrial Flutter Atrial Tachycardia
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