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Incessant Focal Atrial Tachycardia Originating From the Right Inferior Pulmonary Vein With Extremely Short Cycle
Hidemori Hayashi1, Gaku Sekita1, Tohru Minamino1
1Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan, juntendo.ac.jp.
Case Reports in Cardiology
|May 25, 2026
Summary
This case study highlights an unusual focal atrial tachycardia (AT) with a very short cycle length (CL) of 70ms, potentially caused by spiral wave re-entry. Successful catheter ablation was achieved by targeting the earliest activation site outside the pulmonary vein.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Case Reports
Background:
- Focal atrial tachycardia (AT) mechanisms typically involve abnormal automaticity with cycle lengths (CL) >120ms.
- Recurrent symptomatic palpitations in a young female prompted electrophysiologic study.
Purpose of the Study:
- To investigate an atypical case of focal atrial tachycardia (AT) with an extremely short cycle length (CL).
- To determine the origin and mechanism of the tachycardia and assess treatment via catheter ablation.
Main Methods:
- 12-lead ECG and intracardiac recordings using a circular multipolar mapping catheter.
- Electrophysiologic study and catheter ablation targeting the site of earliest activation and shortest CL.
Main Results:
- A 29-year-old female presented with incessant atrial ectopic beats and palpitations.
- Intracardiac recordings revealed repetitive spike potentials with a CL of ~70ms at the posterior right inferior pulmonary vein (RIPV).
- Tachycardia conducted to the left atrium (LA) with 2:1 to 4:1 exit block; successful ablation was performed outside the RIPV.
Conclusions:
- The very short CL (<70ms) suggests a localized spiral wave re-entry mechanism, deviating from typical AT pathophysiology.
- Catheter ablation at the earliest activation site outside the RIPV successfully terminated the tachycardia.
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