Direct Visualization of Acute Left Atrial Pressure Elevation During Atrioventricular Nodal Reentrant Tachycardia

Supraventricular tachycardia (SVT) can acutely elevate left atrial pressure (LAP), yet real-time hemodynamic data during spontaneous episodes are rarely captured. We present a case of real-time capture of LAP during SVT episodes using the implantable V-LAP system (Vectorious Medical Technologies), a new LAP monitoring sensor implanted in the interatrial septum of patients with heart failure.

A 55-year-old female patients with heart failure and an implanted implantable left atrial pressure (V-LAP) sensor presented with symptomatic SVT, which terminated with intravenous adenosine. The V-LAP sensor revealed that LAP rose acutely from 4.4 mm Hg to 16.4 mm Hg during SVT, returning to 3.2 mm Hg after its termination. An electrophysiology study confirmed typical atrioventricular nodal reentrant tachycardia, and successful ablation was performed.

This case provides the first direct visualization of elevated LAP during an atrioventricular nodal reentrant tachycardia episode and suggests that typical atrioventricular nodal reentrant tachycardia ablation was feasible, without device interference, in this patient with a V-LAP sensor. This case highlights the value of integrated electrical and hemodynamic monitoring in managing patients with cardiomyopathy and arrhythmia.

The V-LAP sensor supports the hemodynamic contribution to symptom generation by correlating real-time LAP elevation with arrhythmia. Additionally, standard atrioventricular nodal reentrant tachycardia ablation was feasible in this patient with an interatrial septal sensor, without device interference.