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Reentrant atrial tachycardia originating from the superior vena cava
Kazuhiko Okamoto1, Hiroyuki Ito, Fumiaki Kuma
1Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Higashiku, Fukuoka, Japan 812-8582. h_ito@intmed1.med.kyushu-u.ac.jp
Abstract:
A 52-years old man with a previous pericardiotomy for idiopathic constrictive pericarditis underwent catheter ablation for drug-resistant atrial tachycardia (AT). The mechanism of the AT was considered as reentry because of resetting response and the entrainment phenomenon during AT. We introduced a 64-electrode basket catheter into the superior vena cava (SVC) during AT to obtain precise mapping. A fractionated potential preceding local atrial electrogram was recorded in the SVC. The earliest activation site of the potential was located at the anterior aspect of the SVC, 2 cm above the SVC-right atrium junction determined fluoroscopically. The fractionated potential at this site preceded the onset of the P wave by 115 msec. Radiofrequency catheter ablation at this site eliminated the tachycardia. At 6 months follow-up, the patient is free of AT. Reentrant AT involving the SVC is a candidate of RF ablation. Multielectrode basket catheter is useful for a detailed mapping of the SVC.