Abstract
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.
Learning objective
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiology CasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Right atrial parasystole originating from isolated activities in the right inferior pulmonary vein with an epicardial connection.HeartRhythm Case Rep. 2020; 6: 437-440
- Electroanatomic mapping of the intercaval bundle in atrial fibrillation.Circ Arrhythm Electrophysiol. 2014; 7: 1262-1267
- Epicardial connection between the right-sided pulmonary venous carina and the right atrium in patients with atrial fibrillation: a possible mechanism for preclusion of pulmonary vein isolation without carina ablation.Heart Rhythm. 2019; 16: 671-678
- A simple pacing maneuver to unmask an epicardial connection involving the right-sided pulmonary veins.J Cardiovasc Electrophysiol. 2021; 32: 287-296
- P-wave morphology in focal atrial tachycardia: an updated algorithm to predict site of origin.JACC Clin Electrophysiol. 2021; 7: 1547-1556
- The form and nature of the muscular connections between the primary divisions of the vertebrate heart.J Anat Physiol. 1907; 41: 172-189
- Disappearance of idiopathic outflow tract premature ventricular contractions after catheter ablation of overt accessory pathways.J Cardiovasc Electrophysiol. 2017; 28: 78-84
- Left atrial tachycardia originating from the mitral annulus-aorta junction.Circulation. 2004; 110: 3187-3192
- Left septal atrial flutter: electrophysiology, anatomy, and results of ablation.Circulation. 2004; 109: 2440-2447
- Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: electrophysiological features and ablation outcomes.Heart Rhythm. 2021; 18: 1491-1499
Article info
Publication history
Published online: December 22, 2022
Accepted:
November 28,
2022
Received in revised form:
November 6,
2022
Received:
September 29,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
