Unidirectional block on the mitral isthmus during radiofrequency application for perimitral atrial tachycardia
Abstract We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long-standing persistent atrial fibrillation. During the electrophysiological study, this tachycardia was diagnosed as macroreentrant atrial tachycardia circulating around the mitral annulus. C...
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Published in | Journal of arrhythmia Vol. 29; no. 5; pp. 270 - 274 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Tokyo
Elsevier B.V
01.10.2013
John Wiley & Sons, Inc Wiley |
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Abstract | Abstract We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long-standing persistent atrial fibrillation. During the electrophysiological study, this tachycardia was diagnosed as macroreentrant atrial tachycardia circulating around the mitral annulus. Catheter ablation was performed to treat the tachycardia by targeting the linear region between the annulus and the left inferior pulmonary vein. Although linear radiofrequency application along the mitral isthmus (MI) line resulted in the termination of this tachycardia, a unidirectional conduction block was observed through the MI. Bidirectional conduction block was subsequently achieved by delivering supplemental radiofrequency energies at the gap on the MI. |
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AbstractList | We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long‐standing persistent atrial fibrillation. During the electrophysiological study, this tachycardia was diagnosed as macroreentrant atrial tachycardia circulating around the mitral annulus. Catheter ablation was performed to treat the tachycardia by targeting the linear region between the annulus and the left inferior pulmonary vein. Although linear radiofrequency application along the mitral isthmus (MI) line resulted in the termination of this tachycardia, a unidirectional conduction block was observed through the MI. Bidirectional conduction block was subsequently achieved by delivering supplemental radiofrequency energies at the gap on the MI. Abstract We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long-standing persistent atrial fibrillation. During the electrophysiological study, this tachycardia was diagnosed as macroreentrant atrial tachycardia circulating around the mitral annulus. Catheter ablation was performed to treat the tachycardia by targeting the linear region between the annulus and the left inferior pulmonary vein. Although linear radiofrequency application along the mitral isthmus (MI) line resulted in the termination of this tachycardia, a unidirectional conduction block was observed through the MI. Bidirectional conduction block was subsequently achieved by delivering supplemental radiofrequency energies at the gap on the MI. Abstract We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long‐standing persistent atrial fibrillation. During the electrophysiological study, this tachycardia was diagnosed as macroreentrant atrial tachycardia circulating around the mitral annulus. Catheter ablation was performed to treat the tachycardia by targeting the linear region between the annulus and the left inferior pulmonary vein. Although linear radiofrequency application along the mitral isthmus (MI) line resulted in the termination of this tachycardia, a unidirectional conduction block was observed through the MI. Bidirectional conduction block was subsequently achieved by delivering supplemental radiofrequency energies at the gap on the MI. |
Audience | Academic |
Author | Inada, Keiichi, MD Matsuo, Seiichiro, MD Ito, Keiichi, MD Narui, Ryohsuke, MD Tokuda, Michifumi, MD Yamashita, Seigo, MD Sugimoto, Ken-ichi, MD Tanigawa, Shin-ichi, MD Date, Taro, MD Yamane, Teiichi, MD Yoshimura, Michihiro, MD Hioki, Mika, MD |
Author_xml | – sequence: 1 fullname: Yamashita, Seigo, MD – sequence: 2 fullname: Yamane, Teiichi, MD – sequence: 3 fullname: Matsuo, Seiichiro, MD – sequence: 4 fullname: Ito, Keiichi, MD – sequence: 5 fullname: Narui, Ryohsuke, MD – sequence: 6 fullname: Hioki, Mika, MD – sequence: 7 fullname: Tanigawa, Shin-ichi, MD – sequence: 8 fullname: Tokuda, Michifumi, MD – sequence: 9 fullname: Inada, Keiichi, MD – sequence: 10 fullname: Date, Taro, MD – sequence: 11 fullname: Sugimoto, Ken-ichi, MD – sequence: 12 fullname: Yoshimura, Michihiro, MD |
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Cites_doi | 10.1111/j.1540-8167.2008.01373.x 10.1253/jcj.63.244 10.1111/j.1540-8167.2006.00735.x 10.1161/01.CIR.0000141369.50476.D3 10.1016/j.hrthm.2005.01.027 10.1046/j.1540-8167.2001.00169.x 10.1111/j.1540-8167.2009.01638.x 10.1111/j.1540-8167.1998.tb00896.x 10.1046/j.1540-8167.2004.04524.x 10.1093/europace/eul077 10.1046/j.1540-8167.2002.01098.x 10.1111/j.1540-8167.1998.tb00091.x |
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Keywords | Perimitral tachycardia Catheter ablation Unidirectional conduction block |
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References | Paisey, Betts, De Bono (bib12) 2010; 21 Jaïs, Hocini, Hsu (bib6) 2004; 110 Jaïs, Matsuo, Knecht (bib4) 2009; 20 Tada, Nogami, Naito (bib7) 1999; 63 Matsuo, Jaïs, Hocini (bib9) 2007; 18 Matsushita, Chun, Liem (bib10) 2002; 13 Chugh, Oral, Lemola (bib1) 2005; 2 Gerstenfeld, Callans, Dixit (bib3) 2004; 110 Schumacher, Pfeiffer, Tebbenjohanns (bib5) 1998; 9 Cabrera, Sanchez-Quintana, Ho (bib11) 1998; 9 Deisenhofer, Estner, Zrenner (bib2) 2006; 8 Shah, Haïssaguerre, Takahashi (bib8) 2000; 102 2006; 8 2007; 18 2004; 110 2010; 21 1999; 63 2005; 2 2009; 20 2000; 102 2002; 13 1998; 9 e_1_2_5_13_2 e_1_2_5_9_2 e_1_2_5_8_2 e_1_2_5_7_2 e_1_2_5_10_2 e_1_2_5_6_2 e_1_2_5_5_2 e_1_2_5_12_2 e_1_2_5_4_2 e_1_2_5_11_2 e_1_2_5_3_2 e_1_2_5_2_2 |
References_xml | – volume: 20 start-page: 480 year: 2009 end-page: 491 ident: bib4 article-title: A deductive mapping strategy for atrial tachycardia following atrial fibrillation ablation: importance of localized reentry publication-title: J Cardiovasc Electrophysiol contributor: fullname: Knecht – volume: 18 start-page: 676 year: 2007 end-page: 677 ident: bib9 article-title: Left atrial mitral isthmus block after radiofrequency ablation? publication-title: J Cardiovasc Electrophysiol contributor: fullname: Hocini – volume: 2 start-page: 464 year: 2005 end-page: 471 ident: bib1 article-title: Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation publication-title: Heart Rhythm contributor: fullname: Lemola – volume: 9 start-page: 152 year: 1998 end-page: 163 ident: bib5 article-title: Acute and long-term effects of consecutive radiofrequency applications on conduction properties of the subeustachian isthmus in type I atrial flutter publication-title: J Cardiovasc Electrophysiol contributor: fullname: Tebbenjohanns – volume: 110 start-page: 1351 year: 2004 end-page: 1357 ident: bib3 article-title: Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation publication-title: Circulation contributor: fullname: Dixit – volume: 63 start-page: 244 year: 1999 end-page: 248 ident: bib7 article-title: Quantitative analysis of surface P-wave morphology in isthmus ablation for type 1 atrial flutter: differentiation between complete isthmus block and slow isthmus conduction publication-title: Jpn Circ J contributor: fullname: Naito – volume: 13 start-page: 1098 year: 2002 end-page: 1102 ident: bib10 article-title: Unidirectional conduction block at cavotricuspid isthmus created by radiofrequency catheter ablation in patients with typical atrial flutter publication-title: J Cardiovasc Electrophysiol contributor: fullname: Liem – volume: 110 start-page: 2996 year: 2004 end-page: 3002 ident: bib6 article-title: Technique and results of linear ablation at the mitral isthmus publication-title: Circulation contributor: fullname: Hsu – volume: 8 start-page: 573 year: 2006 end-page: 582 ident: bib2 article-title: Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation publication-title: Europace contributor: fullname: Zrenner – volume: 9 start-page: 1186 year: 1998 end-page: 1195 ident: bib11 article-title: The architecture of the atrial musculature between the orifice of the inferior caval vein and the tricuspid valve publication-title: J Cardiovasc Electrophysiol contributor: fullname: Ho – volume: 21 start-page: 418 year: 2010 end-page: 422 ident: bib12 article-title: Validation of coronary sinus activation pattern during left atrial appendage pacing for beat-to-beat assessment of mitral isthmus conduction/block publication-title: J Cardiovasc Electrophysiol contributor: fullname: De Bono – volume: 102 start-page: 1517 year: 2000 end-page: 1522 ident: bib8 article-title: Differential pacing for distinguishing block from persistent conduction through an ablation line publication-title: Circulation contributor: fullname: Takahashi – volume: 9 start-page: 1186 year: 1998 end-page: 1195 article-title: The architecture of the atrial musculature between the orifice of the inferior caval vein and the tricuspid valve publication-title: J Cardiovasc Electrophysiol – volume: 21 start-page: 418 year: 2010 end-page: 422 article-title: Validation of coronary sinus activation pattern during left atrial appendage pacing for beat‐to‐beat assessment of mitral isthmus conduction/block publication-title: J Cardiovasc Electrophysiol – volume: 110 start-page: 1351 year: 2004 end-page: 1357 article-title: Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation publication-title: Circulation – volume: 9 start-page: 152 year: 1998 end-page: 163 article-title: Acute and long‐term effects of consecutive radiofrequency applications on conduction properties of the subeustachian isthmus in type I atrial flutter publication-title: J Cardiovasc Electrophysiol – volume: 20 start-page: 480 year: 2009 end-page: 491 article-title: A deductive mapping strategy for atrial tachycardia following atrial fibrillation ablation: importance of localized reentry publication-title: J Cardiovasc Electrophysiol – volume: 63 start-page: 244 year: 1999 end-page: 248 article-title: Quantitative analysis of surface P‐wave morphology in isthmus ablation for type 1 atrial flutter: differentiation between complete isthmus block and slow isthmus conduction publication-title: Jpn Circ J. – volume: 18 start-page: 676 year: 2007 end-page: 677 article-title: Left atrial mitral isthmus block after radiofrequency ablation? publication-title: J Cardiovasc Electrophysiol – volume: 13 start-page: 1098 year: 2002 end-page: 1102 article-title: Unidirectional conduction block at cavotricuspid isthmus created by radiofrequency catheter ablation in patients with typical atrial flutter publication-title: J Cardiovasc Electrophysiol – volume: 2 start-page: 464 year: 2005 end-page: 471 article-title: Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation publication-title: Heart Rhythm – volume: 8 start-page: 573 year: 2006 end-page: 582 article-title: Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation publication-title: Europace – volume: 110 start-page: 2996 year: 2004 end-page: 3002 article-title: Technique and results of linear ablation at the mitral isthmus publication-title: Circulation – volume: 102 start-page: 1517 year: 2000 end-page: 1522 article-title: Differential pacing for distinguishing block from persistent conduction through an ablation line publication-title: Circulation – ident: e_1_2_5_5_2 doi: 10.1111/j.1540-8167.2008.01373.x – ident: e_1_2_5_8_2 doi: 10.1253/jcj.63.244 – ident: e_1_2_5_10_2 doi: 10.1111/j.1540-8167.2006.00735.x – ident: e_1_2_5_4_2 doi: 10.1161/01.CIR.0000141369.50476.D3 – ident: e_1_2_5_2_2 doi: 10.1016/j.hrthm.2005.01.027 – ident: e_1_2_5_9_2 doi: 10.1046/j.1540-8167.2001.00169.x – ident: e_1_2_5_13_2 doi: 10.1111/j.1540-8167.2009.01638.x – ident: e_1_2_5_6_2 doi: 10.1111/j.1540-8167.1998.tb00896.x – ident: e_1_2_5_7_2 doi: 10.1046/j.1540-8167.2004.04524.x – ident: e_1_2_5_3_2 doi: 10.1093/europace/eul077 – ident: e_1_2_5_11_2 doi: 10.1046/j.1540-8167.2002.01098.x – ident: e_1_2_5_12_2 doi: 10.1111/j.1540-8167.1998.tb00091.x |
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Snippet | Abstract We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long-standing persistent atrial fibrillation. During... We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long-standing persistent atrial fibrillation. During the... We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long‐standing persistent atrial fibrillation. During the... Abstract We present the case of a patient who developed regular, narrow QRS tachycardia after ablation for long‐standing persistent atrial fibrillation. During... |
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SubjectTerms | Ablation Ablation (Surgery) Adenosine triphosphate Atrial fibrillation Bepridil Cardiac arrhythmia Cardiovascular Catheter ablation Catheters Electrocardiography Electrodes Heart rate Paroxysmal tachycardia Patients Perimitral tachycardia Unidirectional conduction block |
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Title | Unidirectional block on the mitral isthmus during radiofrequency application for perimitral atrial tachycardia |
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