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| Abstract |
Radiofrequency (RF) catheter ablation is widely applied to tachyarrhythmia associated not only with structurally normal hearts but also with relatively mild cardiac anomalies. We present a case of 35 ...year-old female complaining of exercise-induced frequent palpitations caused by atrial tachycardia (AT) originating from giant coronary sinus (CS) connected to persistent left superior vena cava. AT was sensitive to intravenous ATP administration. Electrophysiological study partly using noncontact balloon of EnSite system clarified that two foci of AT were located at the orifice and the distal inner lumen of giant CS. After repetitive applications of RF energy to these origins, AT was not induced by drip infusion of isoproterenol. AT was not evoked by exercise without antiarrhythmic drugs 15 months after the RF ablation. This case indicates that RF ablation guided by noncontact mapping technique should be considered as a therapeutic regimen for AT associated with mild cardiac malformations.
症例は35 歳の女性で，頻回に持続する心房頻拍に対する非薬物治療のために当院に入院した．心房頻拍は薬剤抵抗性で心拡大と心機能低下を認めた．心電図では心房性期外収縮が頻発し，胸部CT検査で右房に開口する巨大冠静脈洞とこれに連続する左上大静脈遺残を認めた．臨床心臓電気生理学検査中に自然に心房頻拍が生じたがATP（20 mg）で停止した．心房性期外収縮の最早期興奮部位は肺静脈にはなく冠静脈洞起源が疑われたため，EnSiteバルーンで冠静脈洞内を慎重にマッピングした．冠静脈洞開口部に最早期興奮部位を認め初回高周波通電で心房頻拍は消失したが，その後冠静脈洞遠位部に起源を有する別の心房頻拍が出現した．EnSiteバルーン留置下での通電が手技上困難であったためEnSiteバルーンを抜去し，Lassoカテーテルで冠静脈洞開口部をマッピングして高周波通電に成功した．本例の心房頻拍は臨床電気生理学的性質やATP感受性，運動誘発性から巨大冠静脈洞内の複数起源の異所性自動能が原因と考えられた．EnSiteシステムは本例のような巨大冠静脈洞内に複数起源を有する心房頻拍のカテーテルアブレーションにおいても有用であると考えられた．show more
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