Right atrial tachycardias related to regions of low-voltage myocardium in patients without prior cardiac surgery: catheter ablation and follow-up results

Abstract

Mapping and ablation of scar-related RA tachycardias is an effective treatment but does not preclude the development of further tachycardias, some of them arising from the LA during long-term follow-up.

Abnormal atrial strain with speckle-tracking echocardiography predicts the arrhythmic substrate of atypical right atrial flutter

“…They described stable circuits around the scar in 7 patients, stable circuits through a “channel” within the scar in 4 patients, and typical atrial flutter in 5 patients. Two previous reports indicated that typical and atypical RA flutter could sometimes be observed in the same patients 6, 7. Typical RA flutter and other tachycardia were not induced in our case.…”

“…Atypical RA flutter in patients without obvious structural heart disease or previous surgical or catheter interventions is rare, and the cause of the scar and low-voltage area in these patients remains speculative 5, 6, 7. In our case, the etiology of regional scarring remained unknown even after various cardiac imaging studies.…”

“…In our case, the etiology of regional scarring remained unknown even after various cardiac imaging studies. The majority of these ATs are scar-related macroreentrant tachycardias and typical atrial flutters 5, 6, 7. Stevenson and colleagues 5 reported the first case series of RA macroreentrant tachycardia in 8 patients without prior atrial surgery.…”

“…Atypical RA flutter was observed in patients who had undergone prior cardiac surgery for obvious structural heart disease 2, 3, 4. In recent years, a few reports have described atypical RA flutter in patients without obvious structural heart disease or previous cardiac surgery 5, 6, 7. Because of the rarity of this occurrence, the arrhythmogenic substrate of atypical RA flutter in these patients is easily underrecognized before catheter ablation.…”

Quantification of the cryoablation zone demarcated by pre- and postprocedural electroanatomic mapping in patients with atrial fibrillation using the 28-mm second-generation cryoballoon

“…[7][8][9] Also, previous correlations between regions of cardiac scar (ablation) and low voltage have been demonstrated. [10][11][12] Scar burden has been used to predict ablation efficacy, 13,14 stroke risk, 15 and, more recently, the site of PV reconnection in patients who have undergone initial AF ablation, but had a recurrence of arrhythmia. 16 The extension of the scar (ablated cardiac tissue) created by the cryoballoon during PVI had not been previously studied with the second-generation cryoballoon.…”