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

Authors
Journal
Journal of Arrhythmia
1880-4276
Publisher
Elsevier
Volume
27
Issue
3
Identifiers
DOI: 10.1016/s1880-4276(11)80048-7
Keywords
  • Accessory Pathway Surgery
  • Accessory Pathway Ablation
  • Atrial Tachycardia Ablation
  • Cavotricuspid Isthmus
  • Atrial Flutter
  • Atrial Tachycardia

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 cavotricuspid isthmus.

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