case_images: PMC10577284_01
case_images: (A,B) Transthoracic echocardiography showing interventricular septal hypertrophy, extensive calcification in the left atrial wall, left ventricle, mitral annulus, and aortic wall; (C,D) cardiac computed tomography showing extensive calcification in the left ventricle, left atrium, atrial septa, and mitral annulus; (E) cardiac magnetic resonance imaging showing diffuse myocardial calcification; (F) radionuclide myocardial perfusion imaging (stress/rest) showing fixed perfusion defects.
case_images: fcvm-10-1207064-g001.jpg
case_images: PMC10577284_01_fcvm-10-1207064-g001.jpg
case_images: F1
case_images: Transthoracic echocardiography showed diffuse myocardial thickening (septal thickness 15.2 mm) and calcification (mainly involving the left atrial wall, left ventricle, atrial septa, mitral annulus, and aortic wall) (Figures 1A, B). Cardiac computed tomography and magnetic resonance imaging also indicated extensive calcifications (Figures 1C-E). Radiographic myocardial perfusion imaging (Stress/Rest) showed fixed perfusion defects (Figure 1F).
case_images: (A) Coronary computed tomography angiography showing no significant coronary stenosis; (B,C) the 3-dimensional reconstruction of the left atrium and pulmonary veins showing calcification in the left atrium; (D) three-dimensional voltage map of the left and right atrium showing areas of low voltage; (E) ablation lesion sets (red dots) of pulmonary vein isolation and posterior left atrial wall isolation; (F) preoperative 12-lead ECG showing atrial fibrillation with a rapid ventricular rate; (G) postoperative 12-lead ECG showing sinus rhythm.
case_images: fcvm-10-1207064-g002.jpg
case_images: PMC10577284_01_fcvm-10-1207064-g002.jpg
case_images: F2
case_images: No significant coronary stenosis was detected on coronary computed tomography angiography (Figure 2A). The 3-dimensional reconstruction of the left atrium and pulmonary veins is presented in Figures 2B, C. Pentaray catheter on the CARTO 3 system (Biosense Webster), which showed areas of low voltage (bipolar voltage amplitude <=1.5 mV) in the region of calcification (Figure 2D). Persistent AF was terminated after circumferential pulmonary vein isolation and electrical posterior box isolation, and no further ablation was performed (Figure 2E). Fortunately, persistent AF was converted to sinus rhythm, and there was no recurrence was observed during the one-year follow-up (Figures 2F, G).