A Case of Catheter Ablation of Atrial Tachycardia in a Patient with Giant Right Atrium after Tricuspid Valve Replacement for Traumatic Tricuspid Valve Regurgitation

Abstract

A 44-year-old female was referred to our hospital for catheter ablation (CA) for symptomatic paroxysmal atrial tachycardia (AT) resistant to anti-arrhythmic drugs (AADs). At 15 years of age, she suffered blunt thoracic trauma due to traffic accident. Tricuspid valve regurgitation was noticed later, and she underwent tricuspid valve replacement (TVR) three times at 18, 20, and 26 years of age. Several years after surgery, she complained of repeated palpitation due to AT. Giant right atrium (RA) was observed on echocardiography and right atriogram. Programmed stimulation easily induced 5 types of AT, and we were able to map three of them. One consisted of a macro-reentrant pattern like figure eight, while two consisted of a focal micro-reentrant pattern. We performed CA for those AT. However, she had recurrence of AT after discharge, so we performed a second session of CA. We performed CA for two types of AT induced in the second session, and eventually those AT were nolonger induced. She has had no palpitation in roughly 1.5 years since CA. There are some reports in the literature of TVR after blunt thoracic trauma, but to our knowledge, this is the first case of CA for such a patient.