Deglutition-Induced Atrial Tachycardia Localised with Contact Force-Guided Activation Mapping.pdfVIP
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Deglutition-Induced Atrial Tachycardia Localised with Contact Force-Guided Activation Mapping.pdf
Heart, Lung and Circulation (2016) 25, e152–e154 1443-9506/04/$36.00 /10.1016/j.hlc.2016.01.014
BRIEF COMMUNICATION
Deglutition-Induced Atrial Tachycardia Localised with Contact Force-Guided Activation Mapping
Alex J.A. McLellan, MBBS a,b,c, Matthew G.D. Bates, MB, ChB, PhD b, Shane D.F. Young, BHMSc, MSc d, Paul B. Sparks, MBBS, PhD b,c*
aDepartment of Cardiovascular Medicine, Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia bCardiology Department, Royal Melbourne Hospital, Melbourne, Vic, Australia cFaculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Vic, Australia dBiosense Webster, Johnson and Johnson, Melbourne, Vic, Australia
Received 26 September 2015; received in revised form 15 January 2016; accepted 21 January 2016; online published-ahead-of-print 16 February 2016
Keywords
Deglutition-induced atrial tachycardia is a rare arrhythmia with a poor response to medical therapy. Electrophysiological study is challenging due to the dependence of induction on swallowing. We present a novel approach to management of deglutition-induced atrial tachycardia arising from right superior pulmonary vein. Use of minimal conscious sedation and repeated swallow challenge inductions, together with contact force-guided mapping were key determinants of success. We review published cases, discussing potential mechanisms including oesophageal distension and neural reflexes.
Deglutition-induced atrial tachycardia Contact-force sensing catheter Pulmonary vein isolation
Case Report
A 65-year-old man presented with swallowing-induced palpitation, refractory to regular medical therapy. His worst symptomatic episode had occurred after swallowing cold water following exercise. He had no other medical history and took no medications. Holter monitoring revealed frequent runs of tachycardia lasting up to 25 beats (Figure 1A). Echocardiogram and computed tomogram (CT) coronary angiogram were normal. The patient underwent elec
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