Dissociated electrical activities in the left atrial posterior wall seen in a patient with focal atrial tachycardia after heart transplantation

Abstract Background It has been reported that elimination of non-pulmonary vein (PV) triggers after PV isolation is a good predictor of atrial tachyarrhythmia free survival. However, precise mapping of triggers outside from superior vena cava (SVC) or left atrial posterior wall (LAPW) are difficult. The aim of this study is to assess the efficacy of self-reference mapping technique to eliminate non-PV triggers originated from outside of primordial pulmonary vein area. Methods Total of 431 patients (446 procedures) underwent atrial fibrillation (AF) ablation in a hospital and in a medical center from January 2017 to March 2019. After isolation of PV, non-PV triggers were induced with isoproterenol and/or adenosine triphosphate. Reproducible non-PV triggers were targeted to ablate using following self-reference mapping technique: A trigger conducts centrifugally and the earliest site should be distinguished from other later activated sites. Using a PentaRay multipolar catheter, the operators annotated the earliest site of local activation and a reference tag was placed. The multipolar catheter was then moved to the reference tag and the process repeated. Ultimately, we identified clusters of early circumferential activation and ablated. Results A total of 32 non-PV triggers excluding the origin from LAPW and SVC were induced in 23 patients. Nineteen triggers (59%) were located in the right atrium and 13 triggers (41%) in the left atrium (Figure 1). All triggers were eliminated with ablation and AF was non-inducible in all patients at the end of the procedure. During the follow-up (529±270 days), 18 patients (77%) were free from atrial tachyarrhythmias after a 3-month blanking period. Three patients received additional ablation procedures for recurrent atrial arrhythmias. No non-PV triggers ablated during the previous procedure were observed. Conclusion A novel self-reference mapping technique is useful for eliminating non-PV triggers in terms of the short- and long-term success. Figure 1. Distribution of non-PV triggers Funding Acknowledgement Type of funding source: None

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Focal atrial tachycardia originating from the epicardial left atrial appendage

Heart Rhythm ◽

10.1016/j.hrthm.2007.12.025 ◽

2008 ◽

Vol 5 (5) ◽

pp. 766-767 ◽

Cited By ~ 40

Author(s):

Takumi Yamada ◽

H. Thomas McElderry ◽

J. Scott Allison ◽

G. Neal Kay

Keyword(s):

Left Atrial ◽

Atrial Tachycardia ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Focal Atrial Tachycardia

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A Patient with Giant Left Atrium Undergoes Orthotopic Heart Transplantation

Texas Heart Institute Journal ◽

10.14503/thij-12-2948 ◽

2014 ◽

Vol 41 (1) ◽

pp. 87-90 ◽

Cited By ~ 2

Author(s):

Sergey Y. Boldyrev ◽

Murat K. Lepshokov ◽

Igor I. Yakuba ◽

Kirill O. Barbukhatty ◽

Vladimir A. Porhanov

Keyword(s):

Left Atrium ◽

Left Atrial ◽

Left Atrial Volume ◽

Posterior Wall ◽

Orthotopic Heart Transplantation ◽

Mechanical Prosthesis ◽

Size Mismatch ◽

Giant Left Atrium ◽

Left Atrial Posterior ◽

Rheumatic Heart

We present a novel technique for resolving the problem of radical size mismatch at the time of orthotopic transplantation. A 48-year-old man presented with chronic rheumatic heart disease and a giant left atrium. Twenty-three years before, he had undergone mitral valve replacement with a mechanical prosthesis. At the time of the repeated intervention, the volume of his left atrium was 350 mL. Surgical features of the transplantation included approximation of the pulmonary vein ostia by gathering sutures intentionally, in order to decrease the area of the left atrial posterior wall and thereby enable appropriate coaptation with the donor left atrium. After the operation, left atrial volume had been reduced to 60 mL.

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