(Circulation. 2000;101:631.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Dual-Loop Intra-Atrial Reentry in Humans
Presented in part at the 19th Scientific Session of the Annual Meeting of the North American Society of Pacing and Electrophysiology, San Diego, Calif, May 6–9, 1998.
From the Department de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
Correspondence to Dr Dipen C. Shah, Department de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque, Ave de Magellan, 33604 Bordeaux-Pessac, France.
Background—Dual-loop atrial reentrant tachycardias have not been clinically described.
Methods and Results—Five patients (3 men, 2 women; mean age, 48±16 years) were studied 24±15 years after surgical closure of an ostium secundum atrial septal defect for drug-resistant atrial tachycardia. Complete tachycardia mapping was performed in the right atrium with multipolar catheters and a 3-dimensional electroanatomic mapping system (Biosense), followed by linear radiofrequency ablation of the narrowest part of each complete loop. Six tachycardias with a typical flutter morphology, a cycle length of 262±40 ms, and a superior f-wave axis (-77±11°) were mapped, 4 with a Biosense map including 106±32 points. Five figure-8 tachycardias had a counterclockwise loop around the tricuspid valve sharing a common anterior channel with a clockwise loop around the lateral atriotomy scar. One tachycardia was thought to have 2 counterclockwise loops around the same obstacles. Radiofrequency delivery in the cavotricuspid isthmus in each case transformed the tachycardia without any pause in a different morphology tachycardia with an inferior P-wave axis (50±42°) and nearly the same cycle length (272±39 ms) but with the periatriotomy loop alone. This arrhythmia required ablation of a second isthmus: between the lower end of the atriotomy and the inferior vena cava in 4 and the superior tricuspid annulus in 1. After a follow-up of 19±6 months, there were no recurrences.
Conclusions—Figure-8 double-loop tachycardias mimicking the ECG pattern of a common atrial flutter occur in some patients after a surgical atriotomy. Ablation of 1 loop produces a sudden transformation to a new reentrant tachycardia formed of the remaining loop that requires ablation at a second isthmus.
Key Words: atrial flutter • catheter ablation • heart defects, congenital • heart septal defects • surgery
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