Late-Onset Perinodal Atrial Tachycardia After Transcatheter Atrial Septal Device Closure

Atrial septal defect (ASD) device closure generally provides excellent long-term outcomes; nevertheless, atrial arrhythmias such as atrial fibrillation and macro-reentrant atrial tachycardias may still appear years later. Although these are well-recognized late sequelae, focal atrial tachycardia (FAT), particularly from the perinodal region after ASD device closure, is exceptionally uncommon.

A 44-year-old woman presented 10 years after percutaneous ASD closure with recurrent palpitations. Electrocardiography demonstrated a narrow-complex regular tachycardia. Electrophysiology study revealed an adenosine-sensitive FAT arising from the perinodal region near the triangle of Koch. Because ablation from the right atrial septum carried a substantial risk of complete heart block, an alternative strategy was pursued. Mapping identified the earliest activation in the noncoronary cusp, where radiofrequency ablation successfully and safely terminated the arrhythmia.

Although complete heart block and macro-reentrant tachycardias are recognized after ASD closure, FAT a decade later is exceedingly rare and, to our knowledge, previously unreported.

FAT can occur long after ASD closure, and noncoronary cusp ablation offers a safe option for perinodal foci.