Macroreentrant Atrial Tachycardia in Patients without Previous Atrial Surgery or Catheter Ablation: Clinical and Electrophysiological Characteristics of Scar‐Related Left Atrial Anterior Wall Reentry

Abstract

Spontaneous LAAW scarring is an unusual cause of MRAT, showing activation patterns with a figure-eight configuration. Radiofrequency CA is a feasible and effective treatment in such cases.

Anatomy of the left main coronary artery of particular relevance to ablation of left atrial and outflow tract arrhythmias

“…Ablation in the anterior LA is commonly performed during ablation of atrial fibrillation (AF) to target complex fractionated atrial electrograms 17 or organized atrial tachycardias. 18,19 Increasingly, the LAA base is targeted to electrically isolate the LAA. 20,21 Although there have been no cases of LMCA injury during LA ablation, a recent report described proximal Cx injury from 35 W of RF energy to the anterior LA during AF ablation.…”

Idiopathic Right Atrial Scar

“…Right and left atrial scars without any prior cardiac surgery have been reported but are rare [1,2]. A 65 year old farmer had recurrent drug refractory atrial tachycardia for which he underwent an EP study with three dimensional mapping and radiofrequency ablation.…”

Localized Reentrant Atrial Tachycardia Without a History of Catheter Ablation in a Patient With Apical Hypertrophic Cardiomyopathy

“…4 In addition, the contiguous aorta-LA area around the mitral annulus is reported to be responsible for the low-voltage area in cases of AT originating from the LA. 5, 6 Ejima et al reported the case of a 69-year-old man with idiopathic dilated cardiomyopathy presenting with localized reentrant AT in the context of atrial fibrillation ablation, 7 and Maeda et al reported the case of a 70-year-old man with small reentrant AT, 8 and in these 2 cases the AT originated from the contiguous aorta-LA area. In the present case, the localized reentrant AT originated from the contiguous right PA-LA area, and compression of the dilated LA by the right PA may have contributed to the fibrosis of the LA anterior wall.…”