• Masato Okada, Koji Tanaka, Yasuharu Matsunaga-Lee, Yuichi Ninomiya, Yuko Hirao, Takafumi Oka, Nobuaki Tanaka, Hiroyuki Inoue, Katsuomi Iwakura, Kenshi Fujii, and Koichi Inoue.
• Cardiovascular Center, Sakurabashi-Watanabe Hospital.
• Int Heart J. 2019 May 30; 60 (3): 761-767.

AbstractA 70-year-old woman was admitted for treatment of supraventricular tachycardia. Ventriculoatrial conduction was revealed through programmed ventricular stimulation; the coronary sinus ostium (CSos) was the earliest atrial activation site. The fast-slow forms of atrioventricular nodal reentrant tachycardia (AVNRT) were induced by ventricular extra-stimuli. During tachycardia, the earliest atrial activation site was located at the bottom of CSos. Radiofrequency (RF) energy application to this site resulted in the delay of local electrical potential, prolongation of tachycardia cycle length, and a shift of the earliest retrograde activation site to the roof of CSos. Subsequent ablation induced a similar shift to the inferior tricuspid annulus and to the right posterior septum. Finally, RF energy application to the right posterior septum resulted in the termination of tachycardia, which was not induced afterward. Multiple shifts in the earliest retrograde atrial activation site along the tricuspid annulus after each slow pathway ablation suggested that annular tissue plays a substantial role as a substrate for AVNRT.

22 keywords...

hide…