Clinical and electrophysiologic characteristics of left septal atrial tachycardia
Nassir F. Marrouche, MD*,
Arne SippensGroenewegen, MD*,
Yanfei Yang, MD*,
Samer Dibs, MD, FACC* and
Melvin M. Scheinman, MD, FACC*,*
* Section of Cardiac Electrophysiology, Department of Cardiology, University of California, San Francisco, California, USA
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Figure 1 (A) Shows a 12-lead electrocardiogram (ECG) for Patient #4 with tachycardia originating from the left midseptal area. The P-wave in the insert is enlarged to show slightly positive P-wave in lead V1, slightly positive in I, biphasic in II, III, aVL, and aVF. (B) Shows a 12-lead ECG for Patient #3 with tachycardia originating from the left inferoposteroseptal area. The P-wave in the insert is enlarged to show isoelectric P waves in lead V1, positive waves in I, II, III, and aVL. (C) Shows a 12-lead ECG for Patient #4 with tachycardia originating from the left midseptal area. The P-wave in the insert is enlarged to show biphasic P waves across the precordium, slightly positive waves in I, II, aVF, and isoelectric P waves in the remainder.
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Figure 2 (A) Shown are simultaneous recordings from surface lead II, Rove catheter records from the left septum, His bundle recording, and distal coronary sinus (CS)1,2 and proximal CS3,4 recordings. The earliest activation site in the left septum was 30 ms before the onset of the surface P-wave. (B) Application of radiofrequency energy to the earliest left septal site during tachycardia results in acceleration before return of sinus rhythm.
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Figure 3 Left anterior oblique of three-dimensional anatomic map for Patient #1. The His bundle recording site (His) superior vena cava (SVC), inferior vena cava (IVC), coronary sinus (CS), and pulmonary veins are noted. The biatrial map shows earliest left septal activation with passive spread to both left and right atrium. LIPV = left inferior pulmonary vein; LUPV = left upper pulmonary vein; RUPV = right upper pulmonary vein.
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