The experience of radiofrequency ablation of atrial tachycardia focus with the use of high-density myocardial mapping

Abstract

The article presents a case of successful treatment of focal atrial tachycardia by radiofrequency ablation using high-density myocardial mapping. The aim of the work was to evaluate the possibilities of high-resolution myocardial mapping by EnsitePrecision® navigation system in the treatment of complex arrhythmias. The analysis of clinical data and results of electrophysiological examination of a 29-year-old patient with continuous recurrent focal atrial tachycardia was carried out. The patient was admitted with complaints of heart rate disorders and frequent short attacks of palpitations. According to electrocardiography, frequent short paroxysms of focal atrial tachycardia were revealed. The patient was taken for electrophysiological examination and radiofrequency ablation of the focus of atrial tachycardia. The focus of atrial tachycardia was located in the anterior septal part of the left atrium, which is a rare localization. After radiofrequency ablation tachycardia was terminated, no complications and recurrences were registered. The patient was discharged with the sinus rhythm. Navigation system EnsitePrecision® enables conducting high-density myocardial mapping, which helps to accurately determine the localization of the source of tachycardia. The radiation load on the patient and ablation time are reduced, which reduces the frequency of complications from the procedure.

Keywords

focal atrial tachycardia / radiofrequency ablation / high-density myocardial mapping

References

[1] Ardashev A.V. Klini­cheskaya aritmologiya. (Clinical arrhythmology.) MEDPRAKTIKA-M. 2009; 852–855. (In Russ.)

[2] Ардашев А.В. Клиническая аритмология. МЕДПРАКТИКА-М. 2009; 852-855.

[3] VNOA. Clinical guidelines for electrophysiological studies, catheter ablation and the use of implantable antiarrhythmic devices. 2017; 354–358. (In Russ.)

[4] ВНОА. Клинические рекомендации по проведению электрофизиологических исследований, катетерной абляции и применению имплантируемых антиаритмических устройств. 2017; 354-358.

[5] Bokeriya L.A., Bokeriya O.L., Melikulov A.Kh. et al. Successful ablation of ectopic atrial tachycardia from the Koch triangle area. Annaly aritmologii. 2011; 8 (4): 55–59. (In Russ.)

[6] Бокерия Л.А., Бокерия О.Л., Меликулов А.Х. и др. Успешная аблация эктопической предсердной тахикардии из области треугольника Коха. Анн. аритмол. 2011; 8 (4): 55-59.

[7] Packer D.L., Bardy G.H., Worley S.J. et al. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am. J. Cardiol. 1986; 57 (8): 563–570. DOI: 10.1016/0002-9149(86)90836-2.

[8] Packer D.L., Bardy G.H., Worley S.J. et al. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am. J. Cardiol. 1986; 57 (8): 563-570. DOI: 10.1016/0002-9149(86)90836-2.

[9] Pokushalov E.A., Turov A.N., Shu­gaev P.L. et al. The effectiveness of catheter ablations in the treatment of atrial ectopic arrhythmias. Vestnik aritmologii. 2006; (43): 5–11. (In Russ.)

[10] Покушалов Е.А., Туров А.Н., Шугаев П.Л. и др. Эффективность катетерных аблаций в лечении предсердных эктопических аритмий. Вестн. аритмол. 2006; (43): 5-11.

[11] Steklov V.I., Rzaev F.G., Patsenko M.B. et al. Radiofrequency ablation of focal atrial tachycardia from right atrial appendage. Klinischeskaya meditsina. 2014; (12): 59–64. (In Russ.)

[12] Стеклов В.И., Рзаев Ф.Г., Паценко М.Б. и др. Радиочастотная аблация очаговой (фокусной) предсердной тахикардии из области ушка правого предсердия. Клин. мед. 2014; (12): 59-64.

[13] Kistler P.M., Roberts-Thomson K.C., Haqqani H.M. et al. P-wave morphology in focal atrial tachycardia. Deve­lopment of an algorithm to predict the anatomic site of ori­gin. J. Am. Coll. Cardiol. 2006; 48 (5): 1010–1017. DOI: 10.1016/j.jacc.2006.03.058.

[14] Kistler P.M., Roberts-Thomson K.C., Haqqani H.M. et al. P-wave morphology in focal atrial tachycardia. Development of an algorithm to predict the anatomic site of origin. J. Am. Coll. Cardiol. 2006; 48 (5): 1010-1017. DOI: 10.1016/j.jacc.2006.03.058.

[15] Revishvili A.Sh., Rashbaeva G.S., Serguladze S.Yu., Panteleeva E.A. Surgical and interventional approaches in the treatment of ectopic atrial tachycardia. Vestik. aritmologii. 2011; (64): 53–55. (In Russ.)

[16] Ревишвили А.Ш., Рашбаева Г.С., Сергуладзе С.Ю., Пантелеева Е.А. Хирургический и интервенционный подходы в лечении эктопической предсердной тахикардии. Вестн. аритмол. 2011; (64): 53-55.

[17] Chen S.A., Tai C.T., Chiang C.E. et al. Focal ­atrial tachycardia: reanalysis of the clinical and electrophy­siologic characteristics and prediction of successful radiofrequency ablation. J. Cardiovasc. Electrophysiol. 1998; (9): ­355–365. DOI: 10.1111/j.1540-8167.1998.tb00924.x.

[18] Chen S.A., Tai C.T., Chiang C.E. et al. Focal atrial tachycardia: reanalysis of the clinical and electrophysiologic characteristics and prediction of successful radiofrequency ablation. J. Cardiovasc. Electrophysiol. 1998; (9): 355-365. DOI: 10.1111/j.1540-8167.1998.tb00924.x.

RIGHTS & PERMISSIONS

Omelyanenko A.S., Mavlyudov T.I., Sapelnikov O.V., Cherkashin D.I., Islamova I.M., Nasibullina A.R.