Development of Lower Loop Reentrant Atrial Tachycardia in a Patient Late after Surgical Operation of Multiple Right-sided Accessory Pathways

DOI 16 References
  • Oginosawa Yasushi
    The Second Department of Internal Medicine, University of Occupational and Environmental Health
  • Abe Haruhiko
    Department of Heart Rhythm Management, University of Occupational and Environmental Health
  • Kohno Ritsuko
    The Second Department of Internal Medicine, University of Occupational and Environmental Health
  • Minamiguchi Hitoshi
    The Second Department of Internal Medicine, University of Occupational and Environmental Health
  • Tamura Masahito
    The Second Department of Internal Medicine, University of Occupational and Environmental Health
  • Takeuchi Masaaki
    The Second Department of Internal Medicine, University of Occupational and Environmental Health
  • Otsuji Yutaka
    The Second Department of Internal Medicine, University of Occupational and Environmental Health

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Abstract

A 50-year-old man developed a symptomatic tachyarrhythmia 22 years after surgical division of multiple right-sided accessory pathways. Electro-anatomical mapping during sinus rhythm revealed an electrically isolated ectopic focus on the right atrial free wall near the tricuspid annulus (TA). Activation map during tachycardia indicated the presence of lower loop reentry (LLR) with collision of the wavefronts in the high right atrium. The isthmus of slow conduction was located between the surgical incision near the posterior TA and the inferior vena cava. LLR was eliminated by radiofrequency linear ablation at the cavo-tricuspid isthmus.

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