A Case with a Perimitral Atrial Tachycardia with an Epi-Endocardium Breakthrough

Complex atrial tachycardias (ATs) after catheter ablation or a MAZE procedure is sometimes difficult to determine the circuits of the tachycardia. A high-density, grid-shapes mapping catheter has been launched, which can be useful for detecting the detail circuits of tachycardias on three-dimensional mapping systems. The signal quality is also important for performing electrophysiological studies (EPSs), such as entrainment mapping, to identify the circuit. This unique mapping catheter has 1 mm electrodes on 2.5 Fr shafts, which improve the signal quality. The high-quality intracardiac electrograms facilitate differentiating small critical potentials, which allows us to perform detailed entrainment mapping in targeted narrow areas. Here, we describe a patient with a perimetral AT with epi-endocardium breakthrough after a MAZE surgery and catheter ablation, which was treated successfully along with detailed entrainment mapping using the HD Grid. This catheter with highquality signals could be a significant diagnostic tool for a classic EPS as well as for the construction of 3D mapping. (Int Heart J 2020; 61: 838-842)

[1]  S. Chacko,et al.  High-resolution mapping of the atria using the HD Grid catheter , 2019, HeartRhythm case reports.

[2]  F. Veglia,et al.  Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up. , 2015, Texas Heart Institute journal.

[3]  C. Schmitt,et al.  Complex Fractionated Atrial Electrogram or Linear Ablation in Patients with Persistent Atrial Fibrillation—A Prospective Randomized Study , 2011, Pacing and clinical electrophysiology : PACE.

[4]  T. Chao,et al.  Differentiating Macroreentrant from Focal Atrial Tachycardias Occurred After Circumferential Pulmonary Vein Isolation , 2011, Journal of cardiovascular electrophysiology.

[5]  S. Knecht,et al.  A Deductive Mapping Strategy for Atrial Tachycardia Following Atrial Fibrillation Ablation: Importance of Localized Reentry , 2009, Journal of cardiovascular electrophysiology.

[6]  F. Morady,et al.  Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation: mechanistic insights, results of catheter ablation, and risk factors for recurrence. , 2007, Journal of the American College of Cardiology.

[7]  Claus Schmitt,et al.  Freedom From Atrial Tachyarrhythmias After Catheter Ablation of Atrial Fibrillation: A Randomized Comparison Between 2 Current Ablation Strategies , 2005, Circulation.

[8]  Claus Schmitt,et al.  Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation. , 2005, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[9]  K. Nademanee,et al.  A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. , 2004, Journal of the American College of Cardiology.

[10]  John L. Sapp,et al.  Electrically Unexcitable Scar Mapping Based on Pacing Threshold for Identification of the Reentry Circuit Isthmus: Feasibility for Guiding Ventricular Tachycardia Ablation , 2002, Circulation.

[11]  F. Marchlinski,et al.  Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. , 2000, Circulation.