PMC5775449_01
Representative electrocardiograms of respiratory cycle-dependent atrial tachycardia (RCAT). A 12-lead electrocardiogram shows incessant atrial short runs linked with respiration induced after sedation. CVP = central venous pressure.
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After induction of anesthesia by propofol with pentamidine infusion, he began to snore upon depression of the tongue, and clinical AT repeatedly appeared linked to breathing (Figure 1).
Three-dimensional electroanatomic mappings and local intracardiac electrocardiograms of the cases. A: Three-dimensional electroanatomic mapping obtained in the anterior-posterior view showed the earliest activation sites of catheter ablation in case 1 (left) and case 2 (center). In case 3 (right), the earliest activation site was located in the low lateral right atrium (RA). In all 3 cases, radiofrequency ablation of the sites eliminated respiratory cycle-dependent atrial tachycardia (RCAT). IVC = inferior vena cava; LA = left atrium; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein; SVC = superior vena cava. B: Electrocardiogram shows that fragmented potential was detected at the earliest activation site (left); RCAT was eliminated during radiofrequency ablation of the site (right). ABL = ablation catheter; CS = coronary sinus; HIS = His bundle.
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Activation mapping showed the earliest site of activation localized to the posterior wall of the left atrium (Figure 2A, left). A single application of radiofrequency energy at 30 W was performed at this site, without change of sinus cycle length or atrioventricular conductivity during ablation, and RCAT was immediately eliminated. The earliest activation site of RCAT was the posterior left atrium in 2 cases and low lateral right atrium in 1 case, with centrifugal activation patterns in all the cases (Figure 2A). All RCATs were completely eliminated after RFCA to the earliest activation sites (Figure 2B).
Relationship between tachycardia onset and respiration. Electrocardiograms of tachycardia initiation and central venous pressure (CVP) in 2 cases, illustrating preceding sinus beats followed by respiratory cycle-dependent atrial tachycardia (RCAT). In case 1, the initiation of RCAT (dotted line) was followed by depression of CVP (arrow); contrarily, in case 2, the initiation of RCAT occurred prior to depression of CVP.
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In 2 cases RCAT appeared after the onset of respiration, and in the remaining case it appeared before respiration onset (Figure 3).