Paroxysmal Long R-P Tachycardia

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Imaging

Background:

• Atrial tachycardia (AT) can originate from various cardiac structures.
• The mitral annulus is a recognized, yet sometimes challenging, focus for AT.
• Understanding the electrophysiological characteristics of mitral annular AT is crucial for effective management.

Purpose of the Study:

• To describe the characteristic features of atrial tachycardia originating from the mitral annulus.
• To evaluate the utility of P wave morphology and atrial activation sequences in localizing mitral annular AT.
• To discuss catheter ablation strategies for mitral annular AT.

Main Methods:

• Case presentation highlighting key electrophysiological findings.
• Analysis of P wave morphology and surface electrocardiogram (ECG).
• Intracardiac electroanatomic mapping along the mitral annulus.
• Discussion of transseptal and retrograde aortic catheter ablation approaches.

Main Results:

• Characteristic P wave morphologies can indicate mitral annulus origin.
• Atrial activation sequence may show earliest activation near the His potential but not consistently.
• Proximal-to-distal coronary sinus activation may or may not be present.
• Detailed mapping along the mitral annulus identified the earliest activation site.

Conclusions:

• Mitral annular atrial tachycardia exhibits specific electrophysiological features.
• Surface P wave analysis and detailed mapping are vital for accurate localization.
• Catheter ablation, via transseptal or retrograde aortic routes, is an effective treatment for mitral annular AT.