Inter-atrial epicardial muscular fibers as a possible source of atrial tachyarrhythmias

Masayuki Hattori; Masako Baba; Hideyuki Hasebe; Kentaro Yoshida

doi:10.1016/j.jccase.2022.12.003

Inter-atrial epicardial muscular fibers as a possible source of atrial tachyarrhythmias

J Cardiol Cases. 2022 Dec 22;27(4):143-147. doi: 10.1016/j.jccase.2022.12.003. eCollection 2023 Apr.

Authors

Masayuki Hattori^{1

2}, Masako Baba^{1

2}, Hideyuki Hasebe², Kentaro Yoshida^{1

2}

Affiliations

¹ Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan.
² Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Abstract

A 22-year-old woman without structural heart disease underwent catheter ablation of frequent premature atrial contractions (PACs). Radiofrequency applications from both the right and left atrium were effective in suppressing or eliminating these PACs. The distance between the right atrial ablation site and the successful ablation site at the right-sided pulmonary venous carina measured 18 mm on the CARTO map, and no cardiac structure, i.e. the inter-atrial septum, was present between those sites. Taken together, the epicardial muscular fibers in the inter-atrial groove were considered to play a role as an arrhythmogenic source of this atrial tachyarrhythmia.

Learning objective: Epicardial muscular fibers connecting the right atrium and right-sided pulmonary venous carina are known to preclude isolation of the veins. This epicardial connection in the interatrial groove can be an arrhythmogenic source or part of a reentrant circuit of atrial tachyarrhythmias.

Keywords: Ablation; Atrial premature complex; Atrial tachycardia; Epicardial connection.

Publication types

Case Reports