A 56-year-old man with permanent atrial fibrillation (AF) underwent circumferential
pulmonary vein (PV) ablation plus additional ablation of atrial areas having fractionated
electrograms. An electroanatomic mapping system (CARTO, Biosense-Webster, Diamond
Bar, CA, USA) was used during the procedure. Computed tomographic (CT) imaging of
the left atrium (LA) performed 2 days before the ablation procedure showed a common
trunk of the left PVs. Fractionated electrograms were concentrated mainly in the posterior
portion of the left PV common trunk ostium. Three months later, the patient underwent
a second electrophysiologic study for palpitation recurrence, with ECG demonstration
of atypical atrial flutter. Biatrial electroanatomic mapping and entrainment pacing
during the procedure showed the LA origin of the flutter, which was sustained by reentry
involving the ridge between the left atrial appendage (LAA) and the left PV common
trunk. Ablation of this region resulted in prompt termination of the arrhythmia. During
2-year follow-up, the patient experienced no recurrences of atrial tachyarrhythmias.
Keywords
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References
- Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations.Circulation. 2006; 113: 186-194
- A stochastic approach for automatic registration and fusion of left atrial electroanatomic maps with 3D CT anatomical images.Phys Med Biol. 2007; 52: 6323-6337
Article info
Publication history
Published online: September 24, 2007
Footnotes
This work was supported by the Fondazione Cassa di Risparmio di Trento e Rovereto.
Identification
Copyright
© 2008 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
