Case 4
A 2-month-old girl with 6 kg of body weight was referred to our clinic
with the diagnosis of tachycardia-induced cardiomyopathy.
Electrocardiogram revealed long RP tachycardia with deep inverted P
waves inferior leads. Echocardiography revealed a global dilatation of
left ventricle (left ventricle end diastolic dimension of 36 mm, z score
+4,3) with severe dysfunction of left ventricle (ejection fraction of
37%). A quadripolar catheter (Esolo FIAB, Italy) was inserted into
esophagus as a reference catheter. Right atrial anatomy was mapped with
Marinr TM CS Steerable Decapolar catheter (Medtronic,
Inc., Minneapolis, MN, USA). During the procedure, long RP tachycardia
was observed in the patient with negative P waves in the inferior leads.
Pacing maneuvers revealed tachycardia mechanism as atypical AVNRT. Upon
this, the activation mapping was obtained from earliest atrial
activations during tachycardia, and ablation was performed in the
posterior region of the right atrium near the entry of the coronary
sinus with power of 30 W and 50oC temperature for 110
seconds. Tachycardia was terminated with accelerated junctional rhythm.
On follow-up echocardiography, left ventricular systolic function has
been improved. She is symptom-free for 2 years.