PMC8113401_01
The surface electrocardiogram during the onset of atrial tachycardia.
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F1
The P wave pattern was negative in lead V1, and the inferior lead was positive and towering, suggesting the origin of the right atrial appendage (Figure 1).
The earliest activation point (located at the apex of the right atrial appendage) measured by (A) the Pentaray electrode 50ms ahead of the body surface P wave; (B) the ST ablation catheter 49 ms ahead of the body surface P wave.
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F2
Under the guidance of the three-dimensional mapping system Carto, the Pentaray mapping electrode was used to perform three-dimensional reconstruction and activation mapping of the right atrium (Figure 2A). A wave of the bipolar electrogram was ahead of the body surface atrial wave 44 ms, and the unipolar electrogram showed a QS shape (Figure 2B). The ablation was performed, with setting the power as 15-25 W, the temperature as 43 C, the saline perfusion rate as 17 ml/min, and the ablation time as 30-40 s at each ablation point. 50 radiofrequency injuries were performed in a total of 50 min, but failed to terminate AT. At the end of the operation, no pericardial effusion was found on transthoracic echocardiography.
(A) The surface electrocardiogram showing sinus rhythm after surgical ablation; (B) The adventitia scar after ablation of the right atrial appendage under thoracoscopic clamping.
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F3
After the operation, the patient's atrial tachycardia was terminated and returned to sinus rhythm, and the heart rate immediately went from 160 to 85 beats/min (Figure 3).
Chest radiographa (A) before operation, cardio-thoracic ratio 0.64; (B) 2 months after operation, cardio-thoracic ratio 0.50.
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F4
The chest radiograph showed that the cardiothoracic shrinkage to normal compared with the preoperative (Figure 4).