Elimination of incisional tachycardias in a patient with atriofascicular tract after surgical isolation and electric destruction of atrioventricular conduction
The case of a female patient, 53 years old, shows effective elimination of 3 types of incisional atrial flutters. At young age the patient underwent surgical isolation of atrioventricular (AV) node with cryoablation of the proximal part of AV node conduction and His bundle ablation - according to the technique used at that time for treatment of Wolff-Parkinson-White pattern. On the electrocardiogram the signs of cardiac preexcitation remained, but tachycardia was not reported anymore. After 10 years atypical atrial flutter was reported, so the patient went to the Department of surgical treatment of tachyarrhythmias in Bakoulev Scientific Center for Cardiovascular Surgery to eliminate tachyarrhythmia. Using entrainment pacing a series of radiofrequency influences in the area of caval tricuspid isthmus was performed, as well as on the lateral wall of right atrium from the superior vena cava to the scar on the right atrium and from the scar to the inferior vena cava. Atypical atrial flutters with a cycle length of 275, 350 and 455 ms were eliminated. Catheter ablation can successfully resolve incisional tachycardia, wherein atriofascicular (Mahaim) accessory pathways conduction may remain for decades because their anatomic substrate includes elements of regular conducting system of the heart.