M. Akhiruddin
University of Hasanuddin, Makassar, Indonesia
Title: Atrioventricular reentrant tachycardia (AVRT) with chronic total occlusion (CTO) in Left Circumflex and Right Coronary Artery: What is Reentry Mechanism ? : A Case Report
Biography
Biography: M. Akhiruddin
Abstract
Background: Supraventricular Tachycardia (SVT) are triggered by a reentry mechanism. Atrioventricular reentrant tachycardia (AVRT) is another common form of paroxysmal SVT. Paroxysmal SVT is observed not only in healthy individuals; it is also common in patients with previous myocardial infarction, mitral valve prolapse, chronic lung disease. AVRT results from the presence of 2 or more conducting pathways. The accessory pathways may conduct impulses in an anterograde conduction, a retrograde conduction, or both. Most of these accessory pathways are located between the left ventricle and left atrium or in the posteroseptal area, less often between the right ventricle and right atrium. Management of patients with concealed accessory pathways divided into acute treatment and ongoing management of orthodromic AVRT. In this report, we describe a case of Atrioventricular reentrant tachycardia (AVRT) with history of Coronary Artery Disease two Vessels Disease (CAD 2VD). Case report: A 56-year-old man admitted to the hospital with major complaints of palpitation since 1 day and no chest pain. History of recurrent palpitation since 3 months ago. He has history of smoking and coronary angiography was CAD 2VD. On admission, ECG in ER showed Narrow QRS complex tachycardia with heart rate 180 bpm, regular, ST depression at lead V2-V6, q patologis di lead III,aVF. The laboratory result within normal limit. From echocardiography we found decreased LV systolic function and mild LV diastolic dysfunction. Result of Coronary Angiography showing chronic total occlusion (CTO) in Left Circumflex and Right Coronary Artery. The patient has performed procedure electrophysiological (EP) Study and radiofrequency ablation (RFA). Three quadripolar catheter was inserted and placed in RV apex, His bundle, HRA via femoral vein . One decapolar catheter placed in CS via internal jugular vein. Pacing from RVA showed retrograd conduction and programmed atrial stimulation induced SVT. The SVT have morphology AVRT posteroseptal accesories pathway. Ablation cathether was placed at the posteroseptal accessory pathway and multiple radiofrequency ablation (RFA) were done. After RFA at the accessory pathway and then pacing could not reinduced SVT. The procedure of electrophysiolgy study and ablation is complete without complication. Conclusion: AVRT with CTO in LCX and RCA is a rare case with recurrent palpitation presentation. As physicians, we need to be highly vigilant in clinical evaluation. This Case report a 56 year old Male with atrioventricular reentrant tachycardia (AVRT) and coronary artery disease two vessels disease has performed procedure of electrophysiological (EP) Study and radiofrequency ablation (RFA) by electrophysiologist.