1/60. Transcatheter ablation of incessant ectopic left atrial tachycardia using radiofrequency current.catheter ablation of ectopic atrial tachycardia has been previously reported in a small number of patients in whom the ectopic focus was predominantly located in the right atrium. We report on a 51-year-old patient with atrial automatic tachycardia originating in the left atrium, in whom successful radiofrequency catheter ablation was performed via a transseptal puncture. The patient had suffered incessant atrial tachycardia for several years, refractory to antiarrhythmic drug treatment and DC-cardioversion. Radiofrequency ablation terminated left ectopic atrial tachycardia and, therefore, should have been attempted before resorting to open heart surgical ablation.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
2/60. Familial association of congenital left heart abnormalities and sustained fetal arrhythmia.hypoplastic left heart syndrome (HLHS) is the most common cause of death from heart disease in the first week of life. There are reports about familial concordance by presumed morphogenetic mechanisms of abnormal embryonic blood flow with phenotypes of varying severity. The risk of having a child with a left heart lesion after a previously affected child may be as high as 5% to 12%. We present case reports from four families in which sustained fetal arrhythmia (three ectopic atrial tachycardias and one severe bradycardia due to excessive ectopic atrial beats) was demonstrated. Within these four families a close relative of the mother (a previous child, a brother, or a nephew) had severe left heart abnormality (three with HLHS and one with severe aortic valve stenosis). The association of sustained fetal arrhythmia of ectopic atrial origin and severe left heart abnormalities could be expected to occur by chance in a very low percentage of cases. We conclude that sustained fetal atrial ectopic arrhythmia is a congenital abnormality and should be considered as a risk factor for inherited congenital heart abnormalities.- - - - - - - - - - ranking = 7keywords = rhythm (Clic here for more details about this article) |
3/60. temperature-sensitive focal atrial tachycardia in the left atrium.temperature sensitivity has not been reported in focal atrial tachycardia. We describe a patient with a left atrial tachycardia whose tachycardia rate was affected by hot and cold drinks. The effects were still evident after autonomic blockade. The arrhythmia focus was located at the entrance of the left upper pulmonary vein. Radiofrequency ablation was carried out, which proved to be difficult, but it was successful after several applications of energy, suggesting an epicardial location of the arrhythmia focus. Sensitivity of atrial tachycardia rate to the temperature of food or drink ingested suggests a left atrial focus with a posterior and possibly epicardial location.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
4/60. Focal ablation of chaotic atrial rhythm in an infant with cardiomyopathy.Chaotic atrial rhythm in infants has been defined similar to multifocal atrial tachycardia in adults, implying a multifocal etiology. However, its ECG appearance resembles atrial fibrillation, which sometimes has a unifocal ectopic mechanism amenable to catheter ablation. Curative focal radiofrequency ablation was performed in a 4-month-old infant with chaotic atrial rhythm and dilated cardiomyopathy. Left ventricular function subsequently returned to normal. Reversibility of associated cardiomyopathy supports aggressive rhythm management of chaotic atrial rhythm. In this patient, the unifocal origin allows insight into the pathophysiology of the rhythm and demonstrates the potential utility of catheter ablation for refractory cases.- - - - - - - - - - ranking = 9keywords = rhythm (Clic here for more details about this article) |
5/60. Atrial tachycardia masquerading as atrial flutter following ablation of the subeustachian isthmus.We report a case of atrial tachycardia masquerading as atrial flutter in a man who had previously undergone catheter ablation for atrial flutter. The recurrent arrhythmia was electrocardiographically almost identical to the prior atrial flutter; at repeat electrophysiologic study, although bidirectional conduction block was observed in the tricuspid annulus-inferior vena caval isthmus, the atrial arrhythmia was readily initiated. Activation mapping suggested typical atrial flutter, but entrainment techniques demonstrated intra-atrial reentry not involving the ablated isthmus. This case illustrates the need to apply entrainment techniques even in cases of apparent "typical" atrial flutter to confirm that putative ablation targets are necessary for tachycardia perpetuation.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
6/60. A typical P-wave morphology in incessant atrial tachycardia originating from the right upper pulmonary vein.Automatic atrial tachycardias often originate from the ostia of the pulmonary veins. P-wave morphology during tachycardia may indicate from which pulmonary vein the tachycardia originates. Two patients with pulmonary vein tachycardias demonstrating atypical P-wave morphology were investigated. One of the patients had a tachycardia with two different cycle lengths. P-wave morphology was evaluated in 12-lead ECGs from two patients with incessant atrial tachycardia, during tachycardia and sinus rhythm. Their tachycardias were successfully ablated at the mouth of the right upper pulmonary vein. Previous studies have demonstrated a positive or negative P-wave configuration in lead aVL originating from this area and a change from a biphasic P-wave in V1 during sinus rhythm to a positive P-wave configuration during tachycardia. Neither of our two patients had such a change in lead V1. One our patients had two tachycardias with different cycle lengths originating from the same area. It is concluded that if an atrial tachycardia with P-wave morphology resembling that of sinus rhythm cannot be located to the right atrium, its origin may be the right upper pulmonary vein.- - - - - - - - - - ranking = 3keywords = rhythm (Clic here for more details about this article) |
7/60. Central venous catheter-induced atrial ectopic tachycardia with reverse alternating Wenckebach periods.A centrally inserted venous catheter may cause atrial ectopic tachycardia. The association of atrial ectopic tachycardia with spontaneous reverse alternating Wenckebach periodicity has rarely been reported. We describe a 4-year-old boy with tetralogy of fallot who developed atrial ectopic tachycardia with reverse alternating Wenckebach periods postoperatively after central venous catheter placement. All such episodes emerged from a 3:2 atrioventricular block, followed by runs of 2:1 atrioventricular block with progressive shortening of the conducted PR intervals. Normal sinus rhythm returned after the catheter was withdrawn to the superior vena cava. Reverse alternating Wenckebach periodicity may be a tachycardia-dependent physiologic phenomenon.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
8/60. Ectopic atrial tachycardia due to aneurysm of the right atrial appendage.We report an infant with ectopic atrial tachycardia, due to an aneurysm of the right atrial appendage, who developed congestive heart failure. Although catheter ablation was transiently successful, tachycardia recurred 2 days later. The aneurysm of the right atrial appendage was resected successfully by surgery, and thereafter she did well, reverting to normal sinus rhythm.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
9/60. Multifocal atrial tachycardia and Ibutilide.Multifocal atrial tachycardia is an electrocardiographic phenomenon seen primarily in the elderly. The hemodynamic consequences of multifocal atrial tachycardia in an elderly woman are presented. Successful treatment with Ibutilide is demonstrated. Treatment with a class III antiarrhythmic agent opposes the frequently accepted mechanism of triggered activity in causing this arrhythmia.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
10/60. Cardiac leiomyosarcoma of the right atrium in a teenager: unusual manifestation with a lifetime history of atrial ectopic tachycardia.A 16-year-old girl presented with atrial fibrillation. Transesophageal echocardiography revealed a right atrial leiomyosarcoma. Her past medical history was remarkable for incessant atrial ectopic tachycardia (AET) beginning in early infancy and continuing throughout childhood and adolescence that was refractive to medical and nonpharmacological treatment. After combined surgical and medical therapy, normal sinus rhythm was restored and the patient is currently in complete remission with no recurrent symptoms or atrial arrhythmias at 31 months after surgery and 23 months after the discontinuation of chemotherapy. Atrial tachycardia may be the first, and for prolonged periods, the only manifestation of a cardiac tumor and should prompt thorough investigation of its underlying morphological substrate.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
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