Successful ablation of macroreentrant left atrial tachycardia after pulmonary vein isolation in a patient with cor triatriatum

摘要

A 69-year-old man with newly discovered nonobstructive cor triatriatum was scheduled for catheter ablation for drug-refractory persistent atypical atrial flutter. Two years previously he had undergone an electrophysiological study for recurrent atrial tachycardia. Four different left atrial (LA) focal tachycardias were observed. Two of the tachycardias were stable enough to be mapped and ablated (one at the base of the LA appendage and the other at the mid-LA septum). Pulmonary vein origin was suspected for the remaining tachycardias, and empiric circumferential antral pulmonary vein isolation (PVI) was performed. Transesophageal echo-cardiography (TEE) or computed tomography (CT) cardiac imaging was not obtained at that time. A dual-chamber pacemaker was implanted after the procedure for preablation sick sinus syndrome. Pacemaker interrogation revealed no significant arrhythmias during 2 years of follow-up until the recent development of a persistent, regular atrial tachycardia with a cycle length of 280 ms and both 1:1 and 2:1 atrioventricular conduction.