An unusual cause of lone atrial fibrillation in a young female subject due to a rapid- cycling focal atrial trigger Shankar Baskar, MD, Mehran Attari,

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Presentation transcript:

An unusual cause of lone atrial fibrillation in a young female subject due to a rapid- cycling focal atrial trigger Shankar Baskar, MD, Mehran Attari, MD, FHRS, Richard J. Czosek, MD, Pierre Jais, MD, PhD, Jeffrey B. Anderson, MD, MPH, MBA, David S. Spar, MD, FHRS HeartRhythm Case Reports Volume 4, Issue 6, Pages 204-208 (June 2018) DOI: 10.1016/j.hrcr.2018.02.007 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 A: Electrocardiogram (ECG) on initial presentation, demonstrating disorganized atrial rhythm with variable A-V conduction consistent with atrial fibrillation. B: ECG demonstrating organized atrial activity with 2:1 A-V conduction consistent with atrial flutter. C: ECG demonstrating initiation of tachycardia with organized atrial rhythm. D: ECG demonstrating slower atrial tachycardia with 2:1 A-V conduction after focal radiofrequency ablation. HeartRhythm Case Reports 2018 4, 204-208DOI: (10.1016/j.hrcr.2018.02.007) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 A: Intracardiac electrograms demonstrating a regular atrial tachycardia recorded in the coronary sinus (CS) catheter that transitions to atrial fibrillation during the electrophysiology study. B: Atrial fibrillation recorded from the CS catheter, which organized to atrial tachycardia, with high-frequency atrial electrograms noted in the PentaRay catheter at the base of the left atrial appendage throughout the recording. C: Atrial fibrillation in the CS catheter with continued high-frequency fractionated atrial electrograms noted in the PentaRay catheter at the base of the left atrial appendage. D: Termination of high-frequency irregular atrial electrograms with radiofrequency ablation at the base of the left atrial appendage. HeartRhythm Case Reports 2018 4, 204-208DOI: (10.1016/j.hrcr.2018.02.007) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 Anteroposterior projection of the left atrium on Carto-3D voltage map using the PentaRay catheter denoting the location of the site of radiofrequency ablation of the atrial focal trigger and the area of the slower atrial tachycardia that occurred after ablation. Closed arrowheads denote the location of the lateral ridge where one would expect the ligament of Marshall and the open arrowhead denotes the left upper pulmonary vein. HeartRhythm Case Reports 2018 4, 204-208DOI: (10.1016/j.hrcr.2018.02.007) Copyright © 2018 Heart Rhythm Society Terms and Conditions