double-gap-in-roof reentrant tachycardia following surgical thoracoscopic atrial fibrillation ablation

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ID: 133728
2015
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Ranked #22 of 63 articles by views in Medical decision making : an international journal of the Society for Medical Decision Making

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Abstract
A case of macro-reentrant tachycardia associated with a box lesion after thoracoscopis left atrial surgical atrial fibrillation (AF) ablation yet to be described. The goal was to clarify the mechanisms and electrophysiological characteristics of this type of tachycardia. A patient was admitted for an EP study following surgical thoracoscopic AF ablation (box lexion formation by right-sided Cobra thoracoscopic ablation). Thoracoscopic ablation was done as the first step of the hybrid ablation approach to the persistent AF; the second step was the EP study. At the EP study, he presented with incessant regular tachycardia (cycle length of 226 ms). An EP study with conventional, 3D activation and entrainment mapping was done to assess the tachycardia mechanism. Two conduction gaps in the superior line (roofline) between the superior pulmonary veins were discovered. The tachycardia was successfully treated with a radiofrequency application near the gap close to the left superior pulmonary vein; however, following tachycardia termination, pulmonary vein isolation was absent. A second radiofrequency application, close to the roof of the right superior pulmonary, vein closed the gap in the box and led to the isolation of all 4 pulmonary veins. No atrial tachycardia recurred during the 6-month follow-up. Conduction gaps in box lesion created by thoracospcopic ablation can present as a novel type of man-made tachycardia after surgical ablation of atrial fibrillation. Activation and entrainment mapping is necessary for an accurate diagnosis.
Reference Key
osmancik2015indiandouble-gap-in-roof Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Pavel Osmancik;Jana Zdarska;Petr Budera;Zbynek Straka
Journal Medical decision making : an international journal of the Society for Medical Decision Making
Year 2015
DOI
10.1016/j.ipej.2015.09.008
URL
http://www.sciencedirect.com/science/article/pii/S0972629215000388
Keywords
Atrial fibrillation ablation

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