Mapping and ablation of anteroseptal atrial tachycardia in patients with congenitally corrected transposition of the great arteries: implication of pulmonary sinus cusps

Abstract

Anteroseptal AT in patients with ccTGA could be eliminated by ablation inside the PSC.

Atrial tachycardia ablation from the pulmonic valve in a patient with congenitally corrected transposition of great arteries

“…A notable feature first demonstrated in our previous study is that the earliest activation site along with a double potential was observed in the pulmonic valve in some cases. 1 In the present type of malformation, the pulmonary artery instead of the aorta overlies the paraseptal region as well, which provided the underlying anatomy to eliminate AT. During mapping, a much earlier double potential was recorded in the pulmonic valve, which was consistent with those cases with {S, L, L}-type ccTGA.…”

“…Several studies have previously reported the electrocardiogram and electrophysiological features as well as successful ablation of focal ATs only in patients with {S, L, L}-type ccTGA. 1 , 2 , 3 , 4 The majority of ATs shared the common features of anteroseptal ATs, eg, comparatively narrow P wave, positive in leads I and aVL, negative/positive in leads V 1 -V 2 , and negative/positive or isoelectric in inferior leads. 1 The P wave during AT was relatively narrower in the present case.…”

“… 1 , 2 , 3 , 4 The majority of ATs shared the common features of anteroseptal ATs, eg, comparatively narrow P wave, positive in leads I and aVL, negative/positive in leads V 1 -V 2 , and negative/positive or isoelectric in inferior leads. 1 The P wave during AT was relatively narrower in the present case. However, the inferior leads of the P wave during AT were positive, which was different from the reported cases with {S, L, L}-type ccTGA.…”

“…It is to be noted that previous studies 1 , 2 , 3 , 4 emphasized the importance of mapping and ablation in the pulmonic valve and beyond. For one reason, in patients with ccTGA, the anatomical structure is unique, with the pulmonary artery instead of the aorta in close anatomical relation to the paraseptal region.…”

“…Previous studies 1 , 3 speculated that the tachycardia mechanism was microreentry, by observing the complex fractionated electrograms or the conduction delay between the double potentials. During the electrophysiological study in the present case, the clinical tachycardia could be reproducibly induced and terminated by atrial stimulation.…”