Atrial Tachycardias Arising from Ablation of Atrial Fibrillation: A Proarrhythmic Bump or an Antiarrhythmic Turn?
Cardiac fluoroscopy in posteroanterior view shows a multipolar spiral catheter (20 mm diameter) and a decapolar catheter. The spiral catheter is mapping left atrial roof. Within a small area of 3 cm2, electrical activity spanning across almost the entire cycle length (212 ms) of tachycardia is demonstrated on bipolar electrograms recorded from dipoles 4-5 to 10-11 on the spiral catheter (yellow background in the zoom). The electrograms are low voltage with maximum amplitude 0.2 mV. This is characteristic of localized reentrant form of focal atrial tachycardia. Instead of a point source, small area harbours tiny circuit which sustains entire cycle length of reentrant tachycardia. The remainder of the atria is activated centrifugally which is consistent with focal tachycardia. Simultaneous recording of dipole 9-10 of decapolar catheter in coronary sinus is also displayed.
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