Author + information
- Received January 5, 2016
- Revision received January 22, 2016
- Accepted January 29, 2016
- Published online October 1, 2016.
- Yang Liu, MD, PhD,
- Yumei Xue, MD,
- Hai Deng, MD,
- Xianzhang Zhan, MD,
- Xianhong Fang, MD,
- Hongtao Liao, MD,
- Wei Wei, MD,
- Yuanhong Liang, MD,
- Zili Liao, MD and
- Shulin Wu, MD∗ ()
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- ↵∗Reprint requests and correspondence:
Dr. Shulin Wu, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, China.
A 29-year-old Chinese male with palpitations was referred to our hospital. The 12-lead electrocardiography demonstrated incessant atrial tachycardia with negative P waves in leads V1 to V2 (Figure 1A). The patient had twice undergone unsuccessful attempts at ablation of right atrial appendage (RAA) tachycardia 2 years prior. High-density endocardial activation mapping with computed tomographic image integration demonstrated the earliest atrial activity at the base of giant RAA (Figure 1B). Subsequently, the appendage was completely excised via the thoracoscopic surgical approach, but the tachycardia could not be terminated. The P-wave morphology in the inferior leads after RAA excision was slightly different from the P-wave before surgical excision (Figure 1C). Endocardial remapping localized the origin of tachycardia to the anterolateral wall of the right atrium (Figure 1D). The earliest atrial activation preceded the surface P-wave by 87 ms (Figure 1E). Radiofrequency applications at this site (30 W at 43°C with 17 ml/min flow) led to termination of tachycardia with the early sharp potential (red arrows in Figure 1E) dissociated from far-field atrial activation (black arrows in Figure 1E). At the successful ablation target, the catheter was noted to become displaced into a chamber located lateral to the right atrial border. Post-procedural angiography performed through the ablation catheter documented catheter placement into the small cardiac vein (red arrows in Figure 1F).
The small cardiac vein is most usually observed as a tributary of the coronary sinus, but it can drain directly to the right atrium in 2% of cases (1). To the best of our knowledge, this is the first description of the small cardiac vein with right atrial orifice as atrial tachycardia origin. Although scanty, the presence of a small cardiac vein opening into the right atrium may provide an anatomical substrate to generate atrial tachyarrhythmias.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 5, 2016.
- Revision received January 22, 2016.
- Accepted January 29, 2016.
- American College of Cardiology Foundation