Successful high-resolution left atrial mapping and catheter ablation of a complex supraventricular tachycardia with transseptal passage through an atrial shunt device.

Abstract

In patients with heart failure with preserved ejection fraction (HFpEF), interatrial shunting performed by permanent devices placed in the interatrial septum is a new treatment concept. Shunting blood from the left to the right atrium reduces left atrial pressure (Figure 1A and B). The Corvia shunt (Corvia Atrial Shunt, Corvia Medical Inc., Tewkesbury, MA, USA) is an interatrial shunt device (IASD) which has shown to reduce left atrial pressure, and to improve heart failure symptoms and quality of life; it is available in one size and has an inner diameter of 8 mm. We present a case report of left atrial reablation performed through an IASD on a patient with HFpEF by using the high-resolution (HR) Rhythmia mapping system (Boston Scientific, Marlborough, MA, USA) and the Orion basket catheter. The 76-year-old female patient was considered for repeat radiofrequency ablation of a symptomatic atrial tachycardia (AT) 6 months after the IASD implantation. Within the last 8 years, the patient has undergone four previous ablations: pulmonary vein isolation (PVI), reisolation of the right superior pulmonary vein, ablation of the ganglionic plexi region, roof line ablation in the left atrium (LA), anterior mitral isthmus line ablation, and a cavotricuspid isthmus ablation (CTI). Due to a sick sinus syndrome, a double lead pacemaker was implanted and the start of antiarrhythmic medication (flecanide) was initiated, which led to freedom from arrhythmias over the last 12 months. However, due to recurrent symptomatic ATs, an atrioventricular node ablation and left atrial catheter ablation were