Gökhan AKSAN, Osman Can YONTAR, Ahmet YANIK

Üç Boyutlu Elektroanatomik Haritalama Sistemi İle Sağ Atriyal Apendiks Taşikardisinin Ablasyonu: Nadir Bir Vaka

Sağ atriyal apendiks (RAA) kaynaklı atriyal taşikardiler (AT) oldukça nadir görülen fokal atriyal taşikardilerdir. 38 yaşında bayan hasta acil servise çarpıntı ve baş dönmesi şikayeti ile başvurdu. Elektrokardiyografide (EKG) 150 atım/dk ventriküler hızında dar QRS’li düzenli taşikardi mevcuttu. Hastanın 5 senedir sık tekrarlayan çarpıntı atakları vardı. Medikal tedavi altında taşikardiyomyopati gelişen hastada işlem onamı alındıktan sonra elektrofizyolojik çalışma (EFÇ) yapılmasına karar verildi. İsoproterenol infüzyonu (1-4 mcg/dk) ile devamlı dar QRS taşikardi indüklendi. Taşikardinin diyagnostik elektrofizyoloji kriterleri AT ile uyumlu idi. Taşikardi esnasında quadripolar 3.5mm cooled-tip Thermocool Smarttouch bi-directional navigasyon katateri ile üç boyutlu (3D) elektroanatomik haritalama sistemi kullanılarak eş zamanlı anatomik ve aktivasyon haritalaması yapıldı. Aktivasyon haritalamasında, taşikardi esnasında sentrifugal yayılım gösteren en erken endokardiyal aktivasyon RAA bazalinde saptandı ve lokal elektrogram Cs referans sinyaline göre 104 msn daha erkendi. Empedans kontrollü radyofrekans ablasyon (RF) (35 W, 42° C, 5-10 g of contact force) en erken sahaya uygulandı ve taşikardi 10 sn içinde sonlandı. RF ablasyon sonrasında 30 dk lık bekleme peryodunda AT gözlenmedi.

Anahtar Kelimeler:

Atriyal taşikardi, Sağ atriyal apendiks

Ablation of Right Atrial Appendage Tachycardia Using 3D Electroanatomic Mapping System: A Rare Case Report

Atrial tachycardias (AT) originating from right atrial appendage (RAA) are quite rare among focal atrial tachycardias. A 38-year-old female patient presented to the emergency room complaining of palpitations and dizziness. Electrocardiography (ECG) showed regular narrow QRS complex tachycardia with a ventricular rate of 150 bpm. The patient had frequent episodes of palpitations for 5 years. Considering the ensuing tachycardiomyopathy under medical treatment, electrophysiological study (EPS) and ablation procedure was planned after having informed consent. During isoproterenol infusion (1-4 mcg/min), a sustained tachycardia with narrow QRS complex was induced. Diagnostic electrophysiological findings were consistent with AT. During tachycardia, by using a three-dimensional (3D) electroanatomic mapping system, simultaneous anatomical and activation mapping was performed with a quadripolar 3.5mm cooled-tip Thermocool Smarttouch bi-directional navigation catheter. Activation mapping demonstrated that the earliest endocardial activation site was basal portion of the RAA where the local electrogram was 104 msn prior to the Cs reference signal during tachycardia which is spreading in a centrifugal fashion. Impedance-controlled radiofrequency ablation (RF) ablation (35 W, 42° C, 5-10 g of contact force) was performed at the earliest site and tachycardia terminated in 10 seconds. No AT observed during the waiting period of 30 min after RF ablation.

Keywords:

Atrial tachycardia, Right atrial appendage,

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