Radiofrequency Ablation of Left Atrial Reentrant Tachycardias in Rheumatic Mitral Valve Disease: A Case Series

• Published in: Pacing and clinical electrophysiology Vol. 40; no. 1; pp. 97 - 103
• Main Authors: PRABHU, MUKUND A., THAJUDEEN, ANEES, VK, AJIT KUMAR, J, THARAKAN, B.V, PRASAD SRINIVAS, NAMBOODIRI, NARAYANAN
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2017
• Subjects: ablation; Adult; Atrium; Cardiac arrhythmia; Catheter Ablation - methods; Catheters; Coronary artery disease; Electrophysiological recording; Female; Heart Atria - surgery; Heart Conduction System - surgery; Heart diseases; Heart Valve Diseases - complications; Heart Valve Diseases - surgery; Humans; left atrial; Male; Middle Aged; Mitral valve; Mitral Valve - surgery; Radiofrequency ablation; reentrant; rheumatic; Rheumatic heart disease; Rheumatic Heart Disease - complications; Rheumatic Heart Disease - surgery; Scars; Sinus; tachycardia; Tachycardia, Atrioventricular Nodal Reentry - diagnosis; Tachycardia, Atrioventricular Nodal Reentry - etiology; Tachycardia, Atrioventricular Nodal Reentry - surgery; Treatment Outcome; left atrial; rheumatic; tachycardia; ablation; reentrant
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.12912

Background Left atrial (LA) reentrant tachycardias are not uncommon in regions where rheumatic heart disease is prevalent. Some of these arrhythmias may be curable by radiofrequency ablation (RFA). However, there are limited data pertaining to this in existing literature. Case Report Three patients who had rheumatic mitral valve disease with past history of surgical‐/catheter‐based intervention and having no significant residual disease had symptomatic atrial flutter despite optimal medical management. An electrophysiological study confirmed an LA focal/micro‐reentrant mechanism in all. There was patchy scarring of the LA, and successful RFA of these arrhythmias could be achieved. Conclusion The focal nature of the scar in these patients may suggest that the rheumatic involvement of the atrium or the hemodynamic consequence of the vulvar lesion causes nonuniform insult to the atrial tissue and limited scar. At least in some patients with limited scarring, early RFA may help in the maintenance of sinus rhythm.