Accurate Identification of Reentrant Circuit and Critical Isthmus of an Atrial Tachycardia Over the Posterior Wall of the Left Atrium Requiring a 1.4-second Single Radiofrequency Energy Application

Abstract

A 61-year-old man with longstanding persistent atrial fibrillation (AF) since 2010 presented to the clinic, having undergone cardioversion for AF in 2016 and AF ablation (pulmonary vein isolation, posterior left atrium isolation, and cavotricuspid isthmus ablation) in July 2017. He developed atrial tachycardia (AT) a few months after the AF ablation procedure and underwent AT ablation (LA posterior wall) in October 2017. However, he experienced early recurrence, requiring a second cardioversion (for AT) and treatment with dofetilide in 2018. He remained primarily in sinus rhythm until September 2020, when he developed persistent AT again, which recurred after a third cardioversion attempt in early October 2020.