Image in Cardiology
Atrial tachycardia ablation in surgically treated congenital heart disease
Ablação de taquicardia auricular em cardiopatía congénita operada
Maria Emanuel Amarala,
, Pedro A. Sousab, Natália Antóniob,c, Miguel Venturab, João Cristovãob, Luís Elvasb
Corresponding author
a Serviço de Cardiologia Pediátrica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
b Departamento de Pacing e Eletrofisiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
c Instituto de Farmacologia e Terapêutica Experimental, Faculdade de Medicina da Universidade de Coimbra, Portugal
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Visualização no cateter de mapeamento PentaRay ≥ 75% do ciclo da taquicardia (desde o bipolo P 1‐2 até ao bipolo P 11‐12) compatível com circuito de microrreentrada. Procedeu‐se a colheita da anatomia da AD com o cateter pentapolar <span class="elsevierStyleItalic">PentaRay</span> (Biosense Webster, J&J), que através dos seus 20 elétrodos permite uma aquisição mais rápida da anatomia. Optou‐se por um cateter de ablação <span class="elsevierStyleItalic">Smartouch</span> (Biosense Webster, J&J) com sensor de contato de forma a garantir um bom contacto com a aurícula direita dilatada. Ambos os mapas, de ativação (B) e de voltagem (C) da taquicardia auricular clínica, foram adquiridos através do <span class="elsevierStyleItalic">software</span> Confidence, que permite uma anotação automática dos pontos. No mapa de voltagem (C) os locais com voltagem ≤ 0,1<span class="elsevierStyleHsp" style=""></span>mV foram definidos como cicatriz (cor vermelha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maria Emanuel Amaral, Pedro A. Sousa, Natália António, Miguel Ventura, João Cristóvão, Luís Elvas" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Maria Emanuel" "apellidos" => "Amaral" ] 1 => array:2 [ "nombre" => "Pedro A." 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Sousa, Natália António, Miguel Ventura, João Cristovão, Luís Elvas" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Maria Emanuel" "apellidos" => "Amaral" "email" => array:1 [ 0 => "mariamanuelaamaral@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pedro A." "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Natália" "apellidos" => "António" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Miguel" "apellidos" => "Ventura" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "João" "apellidos" => "Cristovão" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Luís" "apellidos" => "Elvas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia Pediátrica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Pacing e Eletrofisiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto de Farmacologia e Terapêutica Experimental, Faculdade de Medicina da Universidade de Coimbra, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Ablação de taquicardia auricular em cardiopatía congénita operada" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3118 "Ancho" => 3167 "Tamanyo" => 411438 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Atrial pacing in the coronary sinus with double potential signal ≥100 ms. The double potential was confirmed along the entire cavotricuspid isthmus. ABL: ablation catheter; CS: quadripolar catheter in the coronary sinus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The authors describe the case of a 57-year-old woman with surgically treated superior vena cava sinus-venosus atrial septal defect who underwent an electrophysiology study with the CARTO<span class="elsevierStyleSup">®</span> 3 mapping system (Biosense Webster, J&J) due to recurrent episodes of tachycardia. The patient was found to be in narrow QRS-complex tachycardia, with a cycle length of 310 ms and concentric activation sequence in the coronary sinus (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1A and 1B</a>), suggesting atrial tachycardia (AT) originating from the right atrium (RA). High-density electroanatomical mapping of the RA was performed using the PentaRay catheter (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The AT activation map (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B) indicated micro-reentry and centrifugal activation mainly on the lateral RA wall (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B), coinciding with the border zone of the scar (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C) and reveals ≥75% of the tachycardia cycle on the PentaRay catheter (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A). Radio frequency was applied with the SmartTouch ablation catheter in the initial activation region, resulting in conversion to sinus rhythm (SR).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Under rapid atrial pacing, tachycardia was again induced, with a surface electrocardiogram indicative of counterclockwise atrial flutter with a cycle length of 380 ms (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1C and 1D</a>) confirmed by activation and voltage remapping (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3A and 3B</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Cavotricuspid isthmus (CTI) ablation was performed resulting in conversion to SR. Bidirectional block and the presence of double potential along the CTI line (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>) were confirmed.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">This case shows the advantages of using mapping in patients with congenital heart disease, given that fibrosis in this context enables having several tachycardia circuits.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-02" "fechaAceptado" => "2017-06-20" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Amaral ME, Sousa PA, António N, et al. Ablação de taquicardia auricular em cardiopatía congénita operada. Rev Port Cardiol. 2018;37:271–275.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3389 "Ancho" => 3167 "Tamanyo" => 969681 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">12-lead electrocardiogram (A) and intracavitary electrogram (B) of the clinical tachycardia. The tachycardia cycle length is 310 ms with a concentric activation sequence in the coronary sinus (CS 3-4 → CS 1-2). 12-lead electrocardiogram (C) and intracavitary electrogram (D) in counterclockwise atrial flutter. The baseline tachycardia cycle length is 380 ms. ABL: ablation catheter; CS: quadripolar catheter in the coronary sinus.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2595 "Ancho" => 3167 "Tamanyo" => 791500 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intracavitary electrograms in the coronary sinus catheters (CS 1-2 and CS 3-4), mapping catheters (P 1-2 to P 19-20) and SmartTouch ablation catheters (MAP 1-2 and MAP 3-4) (A). PentaRay mapping catheter revealed ≥75% of the tachycardia cycle (from bipole P 1-2 to bipole P 11-12), compatible with a micro-reentry circuit. RA anatomy was mapped using the pentapolar PentaRay catheter (Biosense Webster, J&J), which enables faster anatomy mapping due to its 20 electrodes. A SmartTouch ablation catheter (Biosense Webster, J&J) with contact sensor was selected to ensure good contact with the dilated right atrium. Both the activation (B) and voltage (C) maps of the clinical atrial tachycardia were acquired using Confidence software, which automatically records points. The locations with voltage ≤0.1 mV were defined as scar (colored red) in the voltage map (C).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2838 "Ancho" => 3190 "Tamanyo" => 631145 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Activation (A) and voltage (B) maps of the second tachycardia. Presence of the entire tachycardia cycle around the tricuspid valve annulus. The red points correspond to the cavotricuspid isthmus line made by RF.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3118 "Ancho" => 3167 "Tamanyo" => 411438 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Atrial pacing in the coronary sinus with double potential signal ≥100 ms. The double potential was confirmed along the entire cavotricuspid isthmus. ABL: ablation catheter; CS: quadripolar catheter in the coronary sinus.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003700000003/v1_201804220424/S2174204918300485/v1_201804220424/en/main.assets" "Apartado" => array:4 [ "identificador" => "74142" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagens em Cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000003/v1_201804220424/S2174204918300485/v1_201804220424/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300485?idApp=UINPBA00004E" ]
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| 2019 July | 44 | 17 | 61 |
| 2019 June | 42 | 10 | 52 |
| 2019 May | 51 | 6 | 57 |
| 2019 April | 36 | 13 | 49 |
| 2019 March | 131 | 16 | 147 |
| 2019 February | 104 | 8 | 112 |
| 2019 January | 125 | 7 | 132 |
| 2018 December | 131 | 15 | 146 |
| 2018 November | 67 | 19 | 86 |
| 2018 October | 96 | 28 | 124 |
| 2018 September | 41 | 18 | 59 |
| 2018 August | 42 | 6 | 48 |
| 2018 July | 23 | 8 | 31 |
| 2018 June | 41 | 9 | 50 |
| 2018 May | 44 | 15 | 59 |
| 2018 April | 41 | 38 | 79 |
| 2018 March | 10 | 23 | 33 |
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