A 22-year-old woman without structural heart disease underwent catheter ablation of frequent premature atrial contractions (PACs). Radiofrequency applications from both the right and left atrium were effective in suppressing or eliminating these PACs. The distance between the right atrial ablation site and the successful ablation site at the right-sided pulmonary venous carina measured 18 mm on the CARTO map, and no cardiac structure, i.e. the inter-atrial septum, was present between those sites. Taken together, the epicardial muscular fibers in the inter-atrial groove were considered to play a role as an arrhythmogenic source of this atrial tachyarrhythmia.
Epicardial muscular fibers connecting the right atrium and right-sided pulmonary venous carina are known to preclude isolation of the veins. This epicardial connection in the interatrial groove can be an arrhythmogenic source or part of a reentrant circuit of atrial tachyarrhythmias.
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Published online: December 22, 2022
Accepted: November 28, 2022
Received in revised form: November 6, 2022
Received: September 29, 2022
Publication stageIn Press Corrected Proof
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.