Bumping-induced electrical dissociation of an arrhythmogenic fossa ovalis
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CASE REPORTS
Bumping-induced electrical dissociation of an arrhythmogenic fossa ovalis Gabriela Hilfiker 1 & Jean-Yves Wielandts 1 & Alexandre Almorad 1 & Mattias Duytschaever 1 & René Tavernier 1 & Sébastien Knecht 1 Received: 27 July 2020 / Accepted: 12 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
A 48-year-old male endurance athlete was referred for ablation of incessant atrial tachycardia (AT). He had undergone ablation for persistent atrial fibrillation 1 year earlier consisting of pulmonary vein isolation plus substrate modification. 3D activation map (CARTO software, Biosense Webster, Diamond Bar, USA) confirmed lasting large circumferential PV isolation and demonstrated the earliest activation during AT at the rightsided fossa ovalis Fig. 1. Sinus rhythm was briefly restored during catheter manipulation at the earliest LAT spot (while inserting the ablation catheter within the 2
* Gabriela Hilfiker [email protected] 1
AZ Sint-Jan, Ruddershove 10, 8000 Bruges, Belgium
layers of the interatrial septum) and endocardial tracings evidenced a rapid and dissociated activity with a cycle length of around 282 ms only recorded within the fossa ovalis (anterior to the previous transseptal puncture site). Consecutive radiofrequency ablation (6 RF applications at 45 W to reach an ablation index > 500) resulted in elimination of the dissociated potentials and definitive sinus rhythm restoration. We consider this concealed AT a highly probable trigger of the clinical AF recurrence after the first procedure. In an 8-month follow-up, the patient stayed free of symptoms.
J Interv Card Electrophysiol Fig. 1 Above: 3D activation map of the right atrium in PA view, red color demonstrating the earliest activation during AT. Tracing below: red stars indicating the dissociated electrical potentials recorded from the ablation catheter (ABL) placed in the fossa ovalis. RAA, right atrial appendage; CS, coronary sinus
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