title: Use of a 3-dimensional electroanatomical mapping system for catheter ablation of macroreentrant right atrial tachycardia following atriotomy.
abstract: The purpose of this study was to utilize a 3-dimensional (3D) electroanatomical mapping system (CARTO) to characterize the reentrant circuit in macroreentrant right atrial tachycardia (AT) following right atriotomy. Right atrial mapping was performed during incessant AT in a patient who had a right atriotomy for closure of an atrial septal defect. During AT, the right atrial free wall exhibited a large contiguous area of low bipolar voltage (< or =0.5 mV, 7.3 cm in length, and 6.3 cm in width). Two discrete scars, showing no electrical potential, were identified within the large low-voltage area. A larger vertical scar (thought to be from the atriotomy) and a smaller second scar (possible inferior vena cava cannulation scar) formed a narrow channel (1.5 cm in width) between these 2 scars. Right atrial activation propagated around the large upper scar, and then propagated through the channel between the 2 scars. A single application of radiofrequency current within the channel eliminated the macroreentrant AT. In conclusion, macroreentrant AT following right atriotomy was associated with 2 discrete scars and utilized the isolated channel between the 2 scars. Ablation within the channel effectively eliminated macroreentrant AT after atriotomy and eliminated the requirement for linear ablation between one or more of the scars and the tricuspid annulus.
authors.affiliation: Department of Medicine, University of Oklahoma Health Sciences Center, and the Department of Veterans Affairs Medical Center, Oklahoma City 73104, USA.
authors.forename: H
authors.initials: H
authors.lastname: Nakagawa
authors.forename: W M
authors.initials: WM
authors.lastname: Jackman
mesh_terms: D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000295:instrumentation*; D002921:Cicatrix / Q000503:physiopathology / Q000601:surgery; D004562:Electrocardiography / Q000295:instrumentation*; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology* / Q000601:surgery*