1. Case presentation
Speaker: Shih- Chung Huang
Kaohsiung Arms General Hospital

2. 802國軍高雄總醫院/黃世鐘醫師

3. Basic information
C/C: A 21 Y/O male present with
symptoms of occasional palpitation, chest
distress for 1-2 years.
Tx: Herbesser (30)1# bid

4. Holter…
+ –
– + –
– – –

5. Location via 12-EKG
V1: (+) – Left side: Sen.(93%) Spe.(88%)
AVL: (+) – Right: Sen.(88%) Spe.(79%)
II,III, AVF: (-) – Inferior
AVR: (-) Right lateral – Crista terminalis
Sen.(100%) Spe.(93%)
Lead V5-6: (-) – Inferomedial
Catheter ablation of cardiac arrhythmias
Shoei.K Stephen Huang
Mark A. Wood P183

6. Focal AT Sites
Right atrium in the LAO view (45°) and location of each focus of AT. The right atrium was
subdivided with a vertical line drawn down the middle of the SVC and IVC (L SVC-IVC)
and a horizontal line at the level of the His bundle (L His).
(Tada H, et al. Simple Electrocardiographic Critera for Identifying the Site of Origin of Focal Right Atrial Tachycardia. PACE 1998;21[Pt. II]:2431-2439

7. History
C/C: A 21 Y/O male present with
symptoms of occasional palpitation
for 1-2 years.
Tx: Herbesser (30)1# bid

8. Basic information

9. Spontaneous initiation

10. Different diagnosis
AT
Atypical AVNRT
AVRT

11. ＋ －
－ ＋
－ －

12. V-A-A-V
A A
552 552
V V

13. V-P-reset ?

14. V-P-His refractory- no reset

15. Termination
A
V

16. Initial impression
Right side atrial tachycardia near inferior
medial region

17. Mapping

18. Mapping

19. Ablation site
RAO 60 LAO 30

20. Ablation- acceleration
Termination
A A A A
V V

21. Final impression
Right side atrial tachycardia near inferior
medial region (segment 3 –TV ring)

22. 謝謝聆聽並請指教 /黃世鐘醫師