Treatment of Macro-Reentry Atrial Tachycardia with Very High-Power, Short-Duration, Temperature-Controlled Ablation of Anterior Line Using an Open-Irrigated Ablation Catheter with Microelectrodes

Patient: Male, 74-year-old Final Diagnosis: Atrial fibrillation Symptoms: Tachycardia Medication:— Clinical Procedure: — Specialty: Cardiology OBJECTIVE: Unusual clinical course BACKGROUND: Treatment of atrial fibrillation and atrial tachycardia (AT) with catheter ablation results in high rates of success with the procedure and on long-term follow-up. A novel ablation catheter with a very high-power, short-duration (vHPSD) ablation mode using 90 W for 4 s has been introduced, which could improve safety and efficacy of catheter ablation, especially for pulmonary vein isolation (PVI). To date, vHPSD mode has only been evaluated for treatment of PVI, but it could be an efficient technique for linear lesions. Here, we present the first use of the novel vHPSD mode alone for catheter ablation in a patient with peri-mitral AT (PMAT). CASE REPORT: A 74-year-old man presented with symptomatic AT. An electroanatomic reconstruction of his left atrium showed PMAT with a potential critical isthmus on the anterior wall. Therefore, ablation of an anterior line was performed. The patient’s AT stopped after 10 applications and less than 40 s of radiofrequency (RF) ablation. Afterward, the anterior line was completed with a total of 29 applications of vHPSD and a RF time of 116 s. PVI and blockage of the cavotricuspid isthmus also were performed. The total procedure time was 107 min. No periprocedural complications occurred. CONCLUSIONS: The present case demonstrates the safety and efficacy of treatment of AT with a novel catheter that delivers vHPSD ablation to an anterior line.