2025 Volume 45 Issue 2 Pages 103-110
The case was a 63-year-old male admitted to the hospital for a cardiopulmonary arrest in year X-3. Following his resuscitation, an emergency percutaneous coronary intervention was performed on the right coronary artery（RCA）（#3）. In year X, atrial tachycardia（AT）was detected, and initiating a rate control therapy proved ineffective. Following consultation with the patient, he elected to undergo catheter ablation. During the electrophysiological study, an AT with a cycle length of 234 ms was induced. The 3D mapping system revealed an isthmus-dependent figure-of-eight reentrant AT on the left atrial posterior wall（LAPW）with a low voltage area（LVA）. The post-pacing interval near the exit site exceeded the tachycardia cycle length by 6 ms. Ablating that site during the AT terminated the arrhythmia. When investigating the cause of the LVA on the LAPW, in the X-2-year coronary angiography it was found that the LA branch originated from the RCA supplying the LVZ. The X-year cardiac synchronous coronary angiography CT scan revealed that the branch had disappeared, even though other coronary artery branches of a similar size were still present. Based on those findings, we hypothesized that an atrial infarction occurred due to decreased coronary blood flow during the cardiac arrest or the progression of atherosclerosis, serving as one of the contributing factors to the formation of the LVA on the LAPW.
