Rapports de cas cliniques et médicaux

Catheter Ablation Effects on Focal Atrial Tachycardia Mistaken for Sinus Tachycardia: A Report of Three Cases

Abstract

Wanpeng Li, Md. Shariful Islam, Xuming Ma, Jihong Wu, Lijun Zhao and Yan Huang*

Purpose: To present the clinical, functional outcomes of radiofrequency ablation in three cases of focal atrial tachycardia arising from the right atrial appendage (RAAT).

Method: A retrospective case series reporting the profile, pre-ablation presentation, catheter ablation process and post-ablation outcome of focal atrial tachycardia originating in the right atrial appendage of three patients who had been masquerading as inappropriate sinus tachycardia before ablation. After catheter ablation, three patients had a minimum of three months follow-up. A retrospective analysis was performed to identify two patients with LV dysfunction, defined as an ejection fraction <50% on echocardiography. Recovery of LV function was also assessed.

Results: The patients were one female and two males aged 29, 14 and 54, respectively. All RAAT was confirmed and eliminated successfully with mapping and ablation. Post-ablation electrocardiogram from two cases demonstrated a negative notched P-wave in leads V1 and V2 during RAAT compared with a beat of sinus rhythm and one case remained the same as pre-ablation ECG pattern in P-wave in leads V1 and V2. After successful ablation, LV function was restored in two patients at three months. The symptoms of palpitations and dyspnea were significantly improved in all patients.

Conclusion: RAAT is likely to be misdiagnosed as sinus tachycardia and induce cardiac insufficiency. Long-term restoration of LV function can be achieved after successful catheter ablation of the tachycardia focus.