A Case was led by Dr. M. S. Chandramouli, Senior Electrophysiologist, from Yashoda Hospitals, Secunderabad 

Abnormal heart rhythms can significantly impact a patient’s quality of life—especially when they occur after a heart attack. This case highlights the successful diagnosis and treatment of focal atrial tachycardia (AT) using advanced electrophysiology study (EPS) and 3D-guided radiofrequency ablation (RFA) at Yashoda Hospitals, Secunderabad.

 

Patient Overview

  • Age / Gender: 58-year-old male

  • Medical History: Recent myocardial infarction (3 months prior)

  • Presenting Symptoms:

    • Recurrent palpitations

    • Rapid pulse rate

    • Episodic discomfort

An ECG performed during symptoms revealed features suggestive of a supraventricular tachycardia, warranting further evaluation.

ECG Findings and Initial Diagnosis

Key ECG characteristics included:

  • PSVT-like narrow complex tachycardia

  • Long RP interval

  • Inconsistent P-P intervals

These findings raised suspicion of focal atrial tachycardia, prompting a recommendation for EPS with possible catheter ablation.

Electrophysiology Study (EPS): Understanding the Rhythm

During the procedure:

  • Decapolar and quadripolar catheters were introduced into the right atrium via the inferior vena cava (IVC)

  • Tachycardia was spontaneously induced during catheter placement

  • The arrhythmia terminated temporarily during entrainment attempts

EPS helped precisely analyze the electrical behavior of the atria and define the mechanism of tachycardia.

Tachycardia Induction & Mechanism Confirmation

  • Atrial extrastimulus pacing (450 ms drive train + 260 ms extrastimulus) reliably induced tachycardia

  • Ventricular overdrive pacing (VOP) showed clear A-V dissociation

  • This conclusively confirmed the diagnosis of atrial tachycardia, ruling out AVNRT or AVRT

3D Electroanatomical Mapping: Pinpoint Accuracy

Using 3D mapping technology, the team:

  • Created an activation and propagation map during ongoing tachycardia

  • Excluded ventricular signals for accuracy

  • Identified the earliest atrial activation at the ostium of the coronary sinus (CS)

  • Correlated findings with early signals in CS-proximal electrodes

This precise localization was critical for safe and effective ablation.

Radiofrequency Ablation (RFA): Targeted Treatment

  • The His bundle location was carefully tagged to avoid injury

  • RF energy was delivered at a site 25 ms earlier than surface atrial activation

  • The arrhythmia terminated successfully during ablation

Post-Ablation Results & Outcome

  • Patient observed for 25 minutes post-ablation

  • Aggressive re-induction attempted with and without isoprenaline

  • No tachycardia could be re-induced

  • Procedure concluded as successful

The patient remained stable with resolution of symptoms.

Why 3D-Guided Ablation Matters

✔ High precision in complex arrhythmias
✔ Reduced fluoroscopy exposure
✔ Safer navigation near critical structures
✔ Higher long-term success rates

This case demonstrates how advanced EP technology enables curative treatment even in patients with recent heart attacks.

Frequently Asked Questions (FAQs)

1. What is focal atrial tachycardia?

It is an abnormal heart rhythm originating from a small, localized area in the atrium that fires rapidly and overrides the normal heartbeat.

2. Is atrial tachycardia dangerous?

While not always life-threatening, persistent AT can cause palpitations, dizziness, heart failure, or worsen existing heart disease if left untreated.

3. Why is EPS needed?

EPS accurately identifies the source and mechanism of the arrhythmia, ensuring targeted and effective treatment.

4. Is radiofrequency ablation safe?

Yes. When performed by experienced electrophysiologists using 3D mapping, it is highly safe and effective.

5. What is the success rate of AT ablation?

Success rates typically exceed 85–90%, especially when the focus is clearly identified.

6. How long does recovery take?

Most patients resume normal activities within 24–48 hours.

7. Will medications still be required after ablation?

In many cases, long-term anti-arrhythmic drugs can be reduced or stopped, based on physician advice.

Expert Care at Yashoda Hospitals

This successful case was led by Dr. M. S. Chandramouli, Senior Electrophysiologist, with support from a highly skilled cath-lab team and advanced EP systems.

Contact Information

Yashoda Hospitals – Secunderabad
📍 Secunderabad, Hyderabad
📞 Appointment & Enquiries: Phone: 090634 20686