PMC9357943_01
Patient's electrocardiogram (sinus rhythm, heart rate 66 beats/min, incomplete right bundle branch block, left anterior branch block, premature atrial, and ventricular beats).
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F1
Electrocardiogram (ECG) showed: sinus rhythm, incomplete right bundle branch block, left anterior branch block, atrial premature beat, and ventricular premature beat (Figure 1).
Echocardiographic of the patient's heart [a left ventricular ejection fraction (LVEF) of 46% (M-type Teichholz method), a right ventricular internal diameter of 26 mm, a right atrial diameter of 54 x 64 mm, diffusely attenuated right ventricular wall pulsation, and the tricuspid plane systolic excursion (TAPSE) was 12 mm, and the tricuspid regurgitation was severe].
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F2
The echocardiogram showed a left ventricular ejection fraction (LVEF) of 46% (M-type Teichholz method), a right ventricular internal diameter of 26 mm, a right atrial diameter of 54 x 64 mm, diffusely attenuated right ventricular wall pulsation, and the tricuspid plane systolic excursion (TAPSE) was 12 mm, and the tricuspid regurgitation was severe (Figure 2).
MRI of the patient's heart [(A) is a whole heart cross-sectional view, which shows a small left atrium and an enlarged right atrium; (B) is a delayed scan, which shows diffuse strip enhancement of the left ventricular lateral wall, apical region, and right ventricular wall, with some transmural-like enhancement].
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F3
The result of magnetic resonance imaging (MRI) (Figure 3) showed that the left atrial and left ventricular internal diameters were normal, the right atrium was 61 mm anterior-posterior, and the right ventricular transverse diameter was 43 mm.
Patient's ECG after this admission (ectopic rhythm, heart rate 93 beats/min, paroxysmal atrial flutter 2:1 conduction, non-specific intraventricular conduction block, prolonged QT interval).
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F4
Still, the ECG after admission showed ectopic rhythm, paroxysmal atrial flutter (2:1 conduction), non-specific intraventricular block, and prolonged QT interval (Figure 4).
Patient's CARTO downstream agitation specimen [retrograde bell-like folding atrial flutter around the tricuspid annulus, tachycardia circumference 300ms, linear ablation along the tricuspid isthmus in the right anterior oblique 30 degrees in (A) and left anterior oblique 45 degrees in (B) position].
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F5
Linear radiofrequency ablation was performed along the tricuspid isthmus (Figure 5), which lead to atrial flutter terminating and recovering sinus rhythm, with intermittent borderline rhythm.
The patient's timeline of admission, diagnosis, and treatment.
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F6
The patient was followed up regularly (Figure 6).