Abstract
A previous study reported primary macroreentrant atrial tachycardia (AT) in the left atrium (LA), including the epicardial circuit on a left atrial anterior wall (LAAW) scar, without any prior cardiac intervention (Miyazawa et al. in J Cardiovasc Electrophysiol 2019; 30: 263-264). However, determining the target for terminating macroreentrant ATs is challenging. The mapping revealed a centrifugal pattern but did not fully elucidate the AT circuit. The reentrant mechanism of these ATs was confirmed using entrainment pacing. The earliest excitation site (EES) was traditionally selected as the ablation site, typically located in healthy tissue. However, our two cases provide new insights into AT termination, including the epicardial bridge across the endocardial LAAW scar, using minimum ablation points, without the need to ablate the healthy EES.
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Shota Tamura: drafting the article,
Kenji Shimeno: the conception and design of the study,
Yusuke Hayashi: revising it critically for important intellectual content,
Takahiko Naruko: revising it critically for important intellectual content,
Daiju Fukuda: final approval of the version to be submitted.
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Supplementary information
Activation map with a Sparkle map in case 1 (MP4 2357 kb)
Activation map with a Ripple map in case 2 (MP4 4358 kb)
Supplementary Figure 1
Electrocardiogram before second procedure in case 1 (PNG 707 kb)
Supplementary Figure 2
Electrocardiogram before second procedure in case 2 (PNG 689 kb)
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Tamura, S., Shimeno, K., Hayashi, Y. et al. Effective ablation of atrial tachycardia with an epicardial circuit—insights from endocardial scars sites: a case study. J Interv Card Electrophysiol 67, 1–3 (2024). https://doi.org/10.1007/s10840-023-01687-6
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DOI: https://doi.org/10.1007/s10840-023-01687-6