Edition 2023/02

Although typical atrial flutter and atrial fibrillation (AF) are not uncommon in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), there is limited information on atrial tachycardia (AT) in this population. A 59-year-old man with a diagnosis of  definite ARVC according to the 2010 Task Force Criteria without overt left ventricular involvement presented with recurrent palpitations. The surface 12-lead electrocardiogram raised the suspicion of atrial tachycardia. The patient had no history of cardiac surgery or cardiac ablation. During tachycardia passive activation of the right atrium (RA) was visible through invasive electroanatomical mapping indicating a left atrial (LA) origin of the tachycardia. High-density mapping of the LA confirmed a reentrant tachycardia with a figure of eight activation pattern originating from a small scar in the anterior LA wall. Radiofrequency catheter ablation targeting the area of slow conduction in this area terminated the tachycardia and rendered it non-inducible.

Abstract

A 27 year-old pregnant woman (29 th  week) was symptomatic for palpitations, dizziness and exertional dyspnea. The heart rate was 130 bpm at rest, up to 180 bpm during mild exertion, without hemodynamic compromise. The Electrocardiogram (ECG) showed atrial tachycardia (AT). With adenosine intermittent interruption of the AT was observed. Metoprolol combined with flecainide allowed to control the ventricular rate to 80-85 bpm followed by conversion to sinus rhythm. The patient was then no longer symptomatic until the second pregnancy, when the same AT recurred. Symptoms were controlled by combining metoprolol and flecainide at an earlier stage.