Localized Reentrant Atrial Tachycardia Without a History of Catheter Ablation in a Patient With Apical Hypertrophic Cardiomyopathy

Multiple focal and macroreentrant left atrial tachycardias originating from a spontaneous scar at the contiguous aorta-left atrium area in a patient with hypertrophic cardiomyopathy: a case report

“…Hori Y. et al demonstrated 68% of the LA very low voltage area (<0.2 mV) overlapped with areas of the LA that contact external anatomical structures, such as the aorta and vertebra, suggesting that contact with external anatomical structures may influence scar formation [13]. Wakabayashi Y. et al reported a patient with HCM who had a spontaneous scar in the LA anterior wall in contact with the right pulmonary artery, implying that HCM-induced pressure overload might contribute to remodeling and fibrosis [6]. In the present case, heterogeneous myocardial damage, including a wide aorta-LA contiguous scar area and electrically normal posterior LA wall, was observed, suggesting that mechanical stress due to the rigid connection played a more important role than pressure overload in fibrosis and scar formation of the LA.…”

“…While most ATs originating from the left atrium (LA) occur in association with a procedure-related scar due to cardiac surgery or catheter ablation [3–5], left ATs related to a non-procedure-related spontaneous scar have been reported in association with a substrate in the LA anterior wall [6]. A rigid aorta-LA connection exists, which may promote myocardial fibrosis [7, 8].…”

Mitral Regurgitation as the Cause of Atrial Tachycardia – 3-Dimensional Mapping and 3-Dimensional Transesophageal Echocardiography –

“…In this case, the channel of the tachycardia was visualized on 3-D electroanatomical activation map, between the left pulmonary vein and left atrial appendage, where the localized dense scar area existed. 2 The MR flow clearly hit this localized spot, which n 83-year-old woman with a history of hypertension, but no past history of cardiac surgery or catheter ablation, had exertional palpitation for 2 years. She had left atrial dilatation (55 mm) and preserved left ventricular ejection fraction (55%) on transthoracic echocardiography, and atrial tachycardia (AT) with 1:1 to 2:1 atrioventricular conduction on 24-h Holter electrocardiography.…”

Characteristics and Long-Term Ablation Outcomes of Supraventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 10-Year, Single-Center Experience

“…Different types of SVAs, including atrial flutter (AFL), atrial tachycardia (AT), atrioventricular nodal reentrant tachycardia (AVNRT), and atrioventricular reentrant tachycardia (AVRT), were first identified in patients with HCM in several electrophysiological studies in the 1980s (8,(24)(25)(26). Interestingly, relatively few studies have evaluated catheter ablation of these SVAs (27)(28)(29). The current guidelines recommend that SVAs other than AF in patients with HCM should be ablated if there is an ablatable substrate (2).…”