case_images: PMC8113401_01
case_images: The surface electrocardiogram during the onset of atrial tachycardia.
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case_images: PMC8113401_01_fcvm-08-659821-g0001.jpg
case_images: F1
case_images: The P wave pattern was negative in lead V1, and the inferior lead was positive and towering, suggesting the origin of the right atrial appendage (Figure 1).
case_images: The earliest activation point (located at the apex of the right atrial appendage) measured by (A) the Pentaray electrode 50ms ahead of the body surface P wave; (B) the ST ablation catheter 49 ms ahead of the body surface P wave.
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case_images: PMC8113401_01_fcvm-08-659821-g0002.jpg
case_images: F2
case_images: Under the guidance of the three-dimensional mapping system Carto, the Pentaray mapping electrode was used to perform three-dimensional reconstruction and activation mapping of the right atrium (Figure 2A). A wave of the bipolar electrogram was ahead of the body surface atrial wave 44 ms, and the unipolar electrogram showed a QS shape (Figure 2B). The ablation was performed, with setting the power as 15-25 W, the temperature as 43 C, the saline perfusion rate as 17 ml/min, and the ablation time as 30-40 s at each ablation point. 50 radiofrequency injuries were performed in a total of 50 min, but failed to terminate AT. At the end of the operation, no pericardial effusion was found on transthoracic echocardiography.
case_images: (A) The surface electrocardiogram showing sinus rhythm after surgical ablation; (B) The adventitia scar after ablation of the right atrial appendage under thoracoscopic clamping.
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case_images: PMC8113401_01_fcvm-08-659821-g0003.jpg
case_images: F3
case_images: After the operation, the patient's atrial tachycardia was terminated and returned to sinus rhythm, and the heart rate immediately went from 160 to 85 beats/min (Figure 3).
case_images: Chest radiographa (A) before operation, cardio-thoracic ratio 0.64; (B) 2 months after operation, cardio-thoracic ratio 0.50.
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case_images: PMC8113401_01_fcvm-08-659821-g0004.jpg
case_images: F4
case_images: The chest radiograph showed that the cardiothoracic shrinkage to normal compared with the preoperative (Figure 4).