1. EKG during incessant AT

2. AVL:(-) or isoelectrical(0) P wave
presence absence
LA RA V1:
SR--biphasic P
tachycardia--positive
+ _ + _ P
II. III. II. III. II. III. II. III.
aVF aVF aVF aVF
superior inferior superior inferior RSPV
Catheter Ablation of Atrial tachycardia, 2002 & Tang et al. JACC 1995

3. During Adenosine Injection
Activation sequence : Right or Left focus?
did not terminate tachycardia (2‐3:1 block) automaticity

4. CS pacing terminate the AT
could not R/O microreentry mechanism

5. The head near the tail :
What is the mechanism ?
Mapping CL = 258 ms (± 55%)
LSPV Tachycardia CL = 550 ms
Latest site
(fractionated signal)
V1
RSPV LAA
CS
Earliest site
(fractionated signal) MP
V1
CS
MV
MP
His
‐ 180 ms
CS Activation to His from anteriorly
and then CS prox‐distal

6. AT 1 : Anterior Mitral Annulus
RAO view LAO view
;LAA
abl cath
abl cath MA
MA
CS CS
Successful
Ablation Site

7. Termination site (1st AT)
142 ms

8. • After the termination of the AT 1, another AT
was induced during isuprel infusion
• The activation sequence was same, CL was
different

9. EKG of second AT
400 ms

10. AT 2 : LAA base near mitral annulus
RAO view LAO view
;LAA
successful site 104 ms to P wave
abl cath abl cath
MA
MA
CS CS
Successful
Ablation Site